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Full text of "Dental state board questions and answers"

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West Virginia University Libraries 



3 0802 102296340 




IRECEIVEID) 

JAN 1 1963 

WEST VIRGINIA UNIVERSITY 
MEDICAL CENTER LIBRARY 



\ 




Wt\t ;Etbrarg 
^Battel jicljntfi 



A GIFT FROM 

Dr. John L. Dunn 



Wheeling, West Virginia 



19 6 2 



/ 





DO NOT CIRCULATE 











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Digitized by the Internet Archive 

in 2012 with funding from 

LYRASIS Members and Sloan Foundation 



http://archive.org/details/dentalboOOgoep 



BOOKS 



R. MAX GOEPP, M. D. 



Medical State Board Questions 
and Answers 

Octavo of 717 pages. Cloth, #4.00 net; 
Half Morocco, $5.50 net. Third Edition. 



Dental State Board Questions 
and Answers 

Octavo of 428 pages. Cloth, $2.75 net. 
Second Edition. 



DENTAL STATE BOARD 
QUESTIONS AND ANSWERS 



BY 



R. MAX GOEPP, M. D. 



.OR OP CLINICAL MBDICINB AT THB PHILADELPHIA POLYCLINIC; A OCIATI 
IN CLINICAL MBDICINB AT JBPPBR80N KBDICAL COLL 'N'T 

VISITING PHYSICIAN TO THE PHILADELPHIA OBNBKAL BOSPITAL 



SECOND EDITION, REVISED 



PHILADELPHIA AND LONDON 

W. B. SAUNDERS COMPANY 
1916 



SCHOOL OP tT 

*EST VIRGINIA miVERSm 
MORGANTOKN, W. VA. 



KKS7 



Copyright, 1912, by W. B. Saunders Company. Reprinted May, 1914. 
Revised, reprinted, and recopyrighted February, 1916. 



Copyright, 1916, by W. B. Saunders Company. 



PRESS OF 
SAUNDER6 COMPANY 
PHILADELPHIA 



PREFACF. TO THE SECOND EDITION 



Aside from a systematic revision of the text and certain changi 
some o! the answers in order to bring them up to date, some additional 
questions were found necessary in preparing the copy for the pr< 
second edition. Nitrous oxid and oxygen anesthesia has come into 
more general use in the routine practice of operative dentistry; certain 
innovations in treatment have been introduced, notably the use of emetin 

and the further development of vaccine therapy in pyorrhea alvcolari>; 
and these, and other matters, have received attention. The character 
of questions asked in State Hoard examinations shows but little change 
from year to year, and such additions as have been made to the text 
are chiefly for the purpose of keeping the book abreast of the times 
general reference handbook. 

The author wishes to express his thanks to his collaborators for their 
valued assistance in the revision of the copy, and particularly to the 
publishers, Messrs. W. B. Saunders Company, who have kindly relieved 
him of the labor of collecting the necessary data in regard to examina- 
tion questions from the current dental literature. 

R. Max Goepp. 
124 South Eighteenth Street, 
Philadelphia, Pa. 

February, iyi6. 



PREFACE 



Tur questions used in the preparation of I Cental State Board Q 
and \n-v. i from the lists published during tl « 

in the various dental journals and arc representative of tin- kind 
of questions asked by rd Ej miners In all tin of the 

Union. While a certain discrimination had to b< ler to 

within reasonable limits, all questions found to have been 
asked repeatedly and by the majority of examining boards have been In- 
cluded and, when necessary, additional questions have hen inserted in 
order to give at the same time a brief, but comprehensive summ 
each subject For convenience of study the text i i arranged approxin 
in the order of presentation followed in systemati . questions 

bearing on the same portion of the subject being grouped together. 

the author's earlier book of the same kind for Medical State B 
Examinations, the present volume is designed primarily for thoa 

paring themselves for examination, but also for the Use of dental StUi 

in their undergraduate work, and for practitioners in general as a ready 
reference hand book. To facilitate reference to any subject on 

information may be desired, a complete index of subjects has also been 
added. 

The answers to questions are given as briefly as is compatible with 
and with a minimum of explanatory or didactic matter, for 
which the student is referred to general text-books. 'The latter have 
b freely used and, as there is no claim to originality, definitions and 
other statements taken from standard works are frequently given without 
quotation marks and without indicating sources of information. 

The author is indebted for cooperation in the work to Dr. Clarem 
Pyle, D. D.S., who prepared the exclusively dental portions of the book, 
and to Dr. . Dorrance, Demonstrator of Applied Anatomy in 

the Dental Department of the University ^i Pennsylvania, for much of 
the genera] work of selecting and preparing the subject-matter, and 
more particular] sections on anatomy and sur 

The chapter on Chemistry and P] . prepared for Questions and 

Answers for medical students and practitioners by Dr. Daniel W. Fetterolf, 
has been adapted to the special needs of dental students and incorporated 
in the book. To all these co-workers the author desires once more to 
express his thanks. R. M. G 

17 16 Locust Si 
Philadelphia, Pa. 



13 



COM I MS 



Phytic \ . . . . 

1 lev hit It) 

Chemistry 

Inorganic 

Irogen 

Water ... 

gen 

1 1 . drogen 1 faudd 

•MC 

Nitrogen 

Nitric Ai 'nl 

Ammonia 

Air 

1 rbon 

Carbon Monoxid and Carbon Dioxid 

Methane and Ethane 

Disinfectants and Antiseptics 

Phosphorus 

Halogens 

Silver 

1 

Mercury 

Sodium 

Arsenic 

Organic Chemistry . 68 

Fermentation and Putrefaction ( , 

Alcohols 70 

Ether - 1 

Chloroform - 1 

Iodoform - 2 

Petroleum - ^ 

Alkaloids <je 

Phvsiologic Chemistry 

Fats ....'. 

Saliva 

Gastric Juice 

"Rone and Muscle 

Metallurgy 

Anatomy 100 

Embryology 

Physiology 144 

The Blood 1 ,4 

The Circulatory System 147 

Respiration 151 

Digestion 1 > j 

Foods 

Absorption 

Metabolism 173 

Animal Heat 

Functions of the External Integument 177 

Motor Apparatus 

The Secretion of Urine 1S1 

15 



1 6 CONTENTS 

PAGE 

The Nervous System 184 

Organs of Special Sense 190 

I development 194 

Pathology 197 

I Regenerations 200 

The Blood 203 

Inflammation 205 

Bones and Joints 209 

Tumors 210 

Infections 215 

Bacteriology 220 

Materia Medica and Therapeutics 234 

Hygiene 269 

Surgery 286 

Congestion and Inflammation 286 

Hemorrhage 289 

Ligations 290 

Tumors 291 

Diseases of Bones and Joints 294 

Orthodontia 313 

Operative Dentistry 322 

Prosthetic Dentistry 355 



Index 395 



DENTAL STATE HOARD QUESTIONS AND 

ANSWERS 



PHYSICS AND CHEMISTRY 



PHYSICS 

Define physics. 

Physics is the science of matter and energy. 

Define matter, force, energy. 

Matter is anything which occupies space and is perceptible to the 
senses. 

Force is that which produces motion, tends to produce motion, or re- 
change. 
Energy is the capacity of an agent to do work. 

Name the essential or physical properties of matter. 
States of aggregation, tenacity, porosity, expansibility, malleability, 
ductility, elasticity, compressibility, and indestructibility. 

Prove the indestructibility of matter. 

Wood, which is composed of C, H, and O, when completely burned, 
is changed into C0 2 and II 2 0, which contain all the C,H, andO originally 
present in the wood, with the quantity of O, consumed from the air re- 
required to bring about the change. 

Name the various states in which matter may exist. 

Solid, liquid, gaseous, and Crooks' or radiant state. 

Distinguish the characteristics of matter in (a) the solid 
state, (b) the liquid state, (c) the gaseous state. 

(a) Cohesion is at its maximum in the solid state but varying with 
different substances giving rise to variations of form, density, tenacity, 
ductility, etc. 

(b) Cohesive force is less in the liquid state. Liquids take the form 
of the vessel containing them. They unite after the passage of a cutting 
implement. The molecules move over each other in comparative free- 
dom. 

(c) Cohesion is entirely absent in the gaseous state, the particles 
unite after the passage of a cutting implement but tend to spread when 
released from containing vessel, they are uniformly compressible and 
expand equally when heated. 

*7 



1 8 PHYSICS AND CHEMISTRY 

Define and give examples of the three varieties of attraction. 

(a) Attraction of gravitation (mass attraction) is the force tending 
to draw masses of all kinds of matter together. Example: The falling 
from a tree of an apple, pear, or other fruit to the earth. 

(b) Attraction of aggregation (homogeneous attraction, cohesion) is 
the attraction exerted between molecules of similar kind. Example: 
A mass of water exists only because of the attraction of aggregation be- 
tween the minute molecules of water. 

(c) Heterogeneous attraction (adhesion) is the attraction exerted be- 
tween molecules of dissimilar kind. Example: Water adheres to wood. 

Define malleability, porosity, and expansibility. Give an 
example of each. 

Malleability is that property possessed by metals which renders them 
susceptible of being rolled or hammered out into thin sheets. Examples: 
gold, silver, platinum. 

Porosity is that property of matter by virtue of which there are un- 
filled spaces (pores) among the molecules. Examples: Water may be 
forced through the pores of wood or cast-iron. 

Expansibility is that property of matter by virtue of which the volume 
of any given mass may be increased. Example: An iron ball, which 
just passes through an iron ring when cold, will not when heated. 

Define elasticity. 

Elasticity is the property of certain substances of returning to their 
original form and size after relieved from a distorting influence. 

(a) Define capillary attraction, (b) Why is it so called? 
(c) Mention some familiar examples. 

(a) It is the mutual action of solids and liquids, by which the surface 
of the liquid is raised or lowered. 

(b) Because solids in the form of hair-like {capillus, sl hair) tubes 
show it in the highest degree. 

(c) If a piece of glass be inserted in water, the liquid will rise a little 
distance above its surface alongside the glass. It rises because the attrac- 
tion between molecules of glass and those of water is stronger than 
that between molecules of water. If a piece of glass be inserted in 
mercury, the liquid will sink below the level. It sinks because the at- 
traction between molecules of glass and those of mercury is weaker than 
that between the molecules of mercury. The oil in a lamp passes up 
the wick, the sap flows through vegetable fiber by capillary attraction. 

(a) What is weight? (b) Name the various systems of 
weight. 

(a) Weight is an arbitrary measure of the force of gravitation. 

(b) Troy or apothecaries', avoirdupois, and metric or decimal. 

Describe the metric system of weights,and measures. 

The unit of linear measure, on which the system is based, is the meter, 
which is equal to one forty-millionth of the earth's circumference around 
the poles. It is divided into ten equal parts called decimeters, each of 



Ml I 

the e Igaifl divided into trn part < ailed COM 

into ten parti called n-^iv:,:^ i in- meta 

1 In- unit ol' i ap.u it) , the li!<r, i. the < nl>e <»l .1 <lr. m n t)i p.irt 

of a meter, [t contains iooo cubic cendmetej nearly equh 

to tin- English quart 

The unit oi weight, the gram, \> tin- ireighl 
distilled water .it | I 

The subdivisions in the * ase «>t the liter and the •: an 
by means o\ tin- Latin prefixes </<</, <>nti, and miUi; multiples an 

rd by die Greek prefixes daca, hecto, and kilo. Thus, 
equals \o meters; out hectoliter equals roo liters; and one kilogram equals 
iooo gratis. The kilogram is equivalent to 2.2 pounds avoirdupois. 

(a) ExprCSB in cubic centimeters of distilled water the \.ilue 
of one fluidounce apothecaries' weight, (b) How main minima 
does a cubic centimeter contain? 

(a) About 30 cubic centimeters. 

(b) About 10 minims. 

How many cubic centimeters represent one fluidram apoth- 
ecaries' measure? 

About 4 c.c; more accurately, 3.75 c.c. 

Express the equivalent of one liter and one meter in units of 
another system, and of one gram in units of Troy weight. 

One liter =33.81 fluidounces, apothecaries' measure. 

One meter=30.37 inches. 

One gram = 15.432 Troy grains. 

Express the equivalent in the metric system of the following 
weights: 1, 5, 10, and 15.5 grains, and 1 ounce. 

1 grain = 0.065 g m - 

5 grains= 0.324 gm. 
10 grains= 0.650 gm. 
15.5 grains = i.ooogm. 

1 ounce=3i.ioo gm. 

Express the equivalent in apothecaries* measure and in the 
metric system of the following: a teacupful, wineglassful, 
tablespoonful, dessertspoonful, teaspoonful, and minim. 

A teacupful = f 3iv =120 c.c. 

A wineglassful =f3ij = 60 cc. 
A tablespoonful = foiv = 15 cc. 
A dessertspoonful = f o i j =7.5 cc. 
A teaspoonful = f 5 j = 3-75 cc. 

A minim = °-95 g r - =0.061 cc. 

State approximately the equivalent (a) in grains of one gram, 
(b) in fluidounces of one liter, (c) in inches of one meter 
(d) the number of minims in one cubic centimeter. 

(a) 15.5; (b) 34; (c) 39.4; (d) 16. 



20 PHYSICS AND CHEMISTRY 

What is a liter? What fraction of a meter is a millimeter? 

A liter is a unit in the metric system for measuring liquid or gaseous 
capacities. It contains iooo cubic centimeters or 33.81 fluidounces. 
A millimeter is one one-thousandth of a meter. 

State approximately the number of (a) inches in one meter, 
(b) grains in one gram. 

(a) 39-37 inches, (b) 15.432 grains. 

Why was the meter selected as a standard unit? 

The meter is supposed to be one ten-millionth of the distance from 
the equator to the pole. 

(a) What is heat and (b) what is the source of animal heat? 

(a) Heat is molecular kinetic energy. 

(b) The appropriation of the potential energy stored in foods and the 
various chemical changes occurring during the process of metabolism. 

How is sensible heat of the human body measured? 

By means of a thermometer. 

(a) Describe a thermometer and (b) explain the difference 
between the Fahrenheit, centigrade, and Reaumur thermometers. 

(a) A thermometer is an instrument for measuring temperatures. It 
consists of a glass tube having a fine, uniform bore, with a bulb at one end. 
The bulb and part of the stem are full of mercury. The space in the tube 
above the mercury is a vacuum (Torricellian vacuum) and the end of the 
tube is hermetically sealed. A scale to measure the expansion or con- 
traction of the thread of mercury is attached to the stem or engraved on 
the stem itself. 

(b) The melting-point of ice (freezing-point of water) is marked 3 2 on 
the Fahrenheit scale, and o on the centigrade and Reaumur scales. The 
boiling-point of water is marked 212 on the Fahrenheit scale, 100 on the 
centigrade scale, and 80 on the Reaumur scale. The Fahrenheit has 
180 degrees between the freezing and the boiling-point of water, the centi- 
grade 100 degrees, and the Reaumur 80 degrees; hence — 

9°F. =5°C.;q°F. = 4 °R. 

What temperature Fahrenheit is equivalent to a tem= 
perature of 28° centigrade? (b) What is the equivalent in 
centigrade degrees of 120 Fahrenheit and (c) of 98.6° F? 

(a) 28 C.Xq=252-5=5°.4 + 32 = 82.4°F. 
28°C. = 82.4°F. 

(b) i2o F.- 3 2 = 88X5 = 440^9=48.88 C. 
i20°F. = 4 8.88° C. 

(c) q8.6°F.-32 = 66.6X5 = 333-9 = 37°C. 
08.6°F. = 37 o C. 

Describe and state the uses of (a) the thermometer, (b) the 
barometer, (c) the hygrometer. 

(a) See previous questions. 



mi uiom] m 31 

(hi \ ; womttm In Its simplest form is i ;htglassf 

about .; ; Inches (800 bub I 1b length, and » lo ed .it one end. I hi 1 1 
filled with men ury, and the opea end i plat ed beneath 1 1 * « - turf* 
cury in a astern. The space In the tube above the mercury i • 1 1 <>rri 
ceUiao vacuum. The mercury Ib tlu* tube falls to .1 point about ^o m< bea 
(700 mm.) from the iurf ace ol the mercury Ib tin- cistern It li an in- 
strument by which changes inthepn the atmotphere can I 
t m t ed and measured it is also used for measuring altitu 

are made of various form I the simp 

of two thermometers (wet and dry bulb thermometers, called 
chrometers) i mounted side by side a shorl distance apart, one he 
bull), and the other a bulb covered with muslin and kepi moist by capillary 

action through Conducting threads of lamp-wick or cotton from | 

water below. The dry hull) indicates the temperature of the air itself; 
while the wet bulb cooled by evaporation, shows usually a lower tem- 
perature (dew point), according to the degree and rapidity of evaporation. 

The hygrometer IS Used to measure indirectly the amount of aqueous vapor 
(humidity) in the atmosphere and to determine the dew point of any 
.specimen of air. A certain form is also employed to determine the relative 
amount of perspiration from the skin. 

What is the boiIing=point (Fahrenheit) of (a) water, (b) 
alcohol, (c) mercury, (d) ether? 

(a) 212 ; (b) 172.4 ; (c) 674.6 ; (d) 96 . 

What is freezing? State the freezing=point (Fahrenheit) of 
(a) water, (b) alcohol, (c) mercury. 

Freezing is the change of a liquid to the solid state by the reduction 
of the temperature. 

(a) 32 , (b)— 202.9 , (c)— 37-9°- 

\\ hat effect does freezing have upon bodies, as a rule? What 
on water? 

Freezing causes contraction and an increase in the weight of a given 
mass of matter by the compaction of the molecules. Freezing of water 
causes expansion and a decrease in the weight of a given mass. 

Define latent heat and specific heat. 

Latent heal is the heat present in a substance not manifesting itself as 
as temperature, but required to retain it in its state of aggregation. Speeific 
heal is the relative amount of heat required to raise equal weights of differ- 
ent substances through the same range of temperature, one being taken as 
the standard. 

Name (a) two substances that are fusible, (b) two that are 
volatilized by heat, (c) two that are unaffected by heat. 

(a) Iron and lead, (b) sulphur and iodin, (c) carbon and silicon. 

Describe the effect produced by increasing the vibration of 
the molecules of a mass. 



2 2 PHYSICS AND CHEMISTRY 

Increase of heat, increase of volume, change of state, and overcoming 
of pressure. 

Define specific gravity. Give a method of determining the 
specific gravity of a solid substance insoluble in, and heavier 
than water. 

Specific gravity is the relative weight of equal volumes of different 
substances, one being used as a standard. 

Find the weight of the substance in air and then in water (under standard 
conditions), and divide its weight in air by its loss of weight in water; the 
quotient will be the specific gravity. Example: 

Weight of iron in air = 115.56 gr. 

Weight of iron in water = 100.08 gr. 

Loss of weight in water = 15.48 gr. = the weight of the volume of 
water displaced, hence — 

115.56-7-15.48=7.46 = 1116 specific gravity of iron. 

What is the unit of comparison in determining the specific 
gravity of (a) solids and liquids ; (b) of gases? 

(a) Pure water at 4 C. and a barometric pressure of 760 millimeters, 
according to the French system; or 62 F. and 30 inches barometric pres- 
sure, according to the English system. The specific gravity of solids and 
liquids is usually taken at a temperature of 15.5 C. (6o° F.). 

(b) Air or hydrogen at o° C. and 760 millimeters, according to the 
French system; or 6o° F. and 30 inches pressure, according to the English 
system. 

Describe (a) a hydrometer, (b) a pyknometer. Name some 
varieties of hydrometers. 

(a) A hydrometer (densimeter) is an instrument employed for deter- 
mining the specific gravity (density) of liquids. It consists of a graduated 
glass tube, with one or two bulbs at the lower end loaded with mercury or 
shot. 

(b) A pyknometer is a glass specific gravity bottle having a thermometer 
and a very narrow or capillary tube. Varieties: alcoholometer, lactom- 
eter, urinometer. 

Explain each of the following: Reflection of light, refrac- 
tion of light, dispersion of light. 

A ray of light striking a polished surface is bent at an angle corre- 
sponding to the angle with which it strikes the surface. 

Refraction of light is the bending of light rays when passing through 
translucent materials of different density. 

Dispersion is the splitting of a ray of white light into the seven colors 
of the spectrum. 

Describe a spectroscope. What is meant by spectrum 
analysis. 

It consists of a prism and of three telescopes directed toward it. Light 
is cast through a slit in the outer end of one telescope and is collected 
at the other end by a convex lens, rendering the beams parallel. They 



IUAI 






arc then dispersed bj 

red thro econd telescope The third tube, a fine sea 

metsuremenl oi the relative position o! lines 01 i ted to the 

ere oi the observei I hi-> scale •rhen Illuminated by a candle : 

me end of tube is reflected on the face of the pri tnandi eenthi 
rving telescope Spectrum anal] rs to the determination o 

ituents *»t" a substance by means <>t" the ipe b I 

is placed in a container between the light and I Dil 

substances produce characteristic bands <>i color when 

tlu- spectroscope 

What is meant by the terms a effervescence, b efflor- 
escence and ic deliquescence? 

ia the agitation or ebullition which is produ< ed bj 
escape *>t' a um^ through a liquid, independently of tlu- heat of the mixture; 
such, for instance, as results from the mixture of an add and a carboi 

(l>) Efflorescence is the conversion of a solid Substance into a pulverulent 
state by exposure to the air, due to the loss of water of crystalli/. 
Example: Crystalline magnesium sulfate exposed to air becomes a white 
powder. 

(c) Deliquescence is the conversion of a solid salt into the liquid forr- 
the absorption of moisture from the air, as occurs when gold chl 
calcium chlorid, magnesium chlorid or cobalt nitrate is exposed to the air. 

Define an amorphous substance. 

An amorphous substance is a solid of noncrystalline character. 

Define evaporation, distillation, filtration, saturation, and 
sublimation. 

Evaporation is the passing of a liquid into the state of vapor. This 
process occurs at all temperatures. 

Distillation is the vaporization of a liquid by the application of heat, 
and recondensation into the liquid state by conducting the vapor through 
a cooled tube or vessel. 

Filtration is the process of separating liquids from solids by means of 
some porous membrame or septum. 

Saturation is the incapacity of a liquid to retain any more of the dis- 
solved substance after it has exercised its powers of solvency to its utmost 
extent. 

Sublimation is the process of separating a volatile solid substance from 
one which is not volatile by the application of heat. 

What is dialysis and how may a dialvzer be constructed? 

Dialysis is the process of separating crystallizable (crystalloidal) from 
noncrystallizable {colloidal) substances by suspending a mixture of both 
upon a porous diaphragm which has its under surface in contact with 
water. A dialvzer may be constructed with two circular glass vessels. 
the one larger than the other, so that the smaller may be suspended in the 
larger, the bottom of the smaller vessel being composed of some porous 
substance such as parchment paper. 



24 PHYSICS AND CHEMISTRY 

ELECTRICITY 

Define electricity. 

The exact nature of the electricity which makes itself evident in so 
many ways has never been determined. Provisionally, it may be regarded 
as that which is transferred from one body to another body when the two 
become oppositely electrified. 

What is (a) permanent magnet, (b) an electro magnet? 
State how each may be made. 

A permanent magnet is one that once magnetized retains this property 
indefinitely. It is made by rubbing a magnetized piece of steel on one that 
is not magnetized. An electro magnet is of soft iron and only retains its 
magnetic property while under the influence of an electric current. It is 
made by enclosing a bar of soft iron in a coil of insulated wire and pass- 
ing a current of electricity through the wire. 

Define a volt, a watt, a coulomb, an ohm, an ampere, and 
a milliampere. 

A volt is the unit of electromotive force. 

A watt is the power of an electric current of one ampere at one volt. 

A coulomb is the quantity of electricity conveyed by the current of an 
ampere per second. For the evolution of i.oi gram of hydrogen 96.54 
coulombs must pass through the electrolyte. 

An ohm is the unit of resistance offered to a current of electricity by 
a pure copper wire one millimeter in diameter and 48.61 meters long at 
18.3 c. 

An ampere is the unit of current strength carrying one coulomb per 
second. 

A milliampere is the one-thousandth part of an ampere. From 1 to 100 
or more milliamperes may be administered to a patient for medicinal 
purposes. 

Define galvanic (voltaic) electricity. 

A glavanic current of electricity is the result of chemical action having 
but low potential with large quantity. Such a current is produced when 
a plate of zinc and one of carbon, joined by a wire, are partly immersed in 
dilute sulfuric acid, without being in contact. The current passes from 
the most active chemical substance (zinc) through the fluid to the less 
active (carbon). 

Define the faradic current of electricity. How is it produced? 

The faradic or induced current is an interrupted, or alternating 
current of high potential but small quantity; it is produced by the in- 
duction of a current into a coil of long, thin, insulated wire surrounding 
another coil of short, thick, insulated wire, through which a galvanic cur- 
rent alternately flows. 

Describe two galvanic cells mentioning the chemicals used. 

Grove-cells — vulcanized rubber cup containing diluted sulfuric acid 
and a V-shaped piece of zinc. Suspended in the cup is a second, porous, 



KLKi IKK I 1 \ 






cup tontaining ttlOng nitric . n i < I ami a sheet nf platinum Tin 

connected, one from the rin< place and * > i » < - from the j)iatiinnn 

haniclicll U Containing saturated solution of < uj.ri< sul 

fan- in whii h .stands a copper cylinder. In si. it- this cylinder lit > a j 
it'll containing sulfuric aad ami into this dip a line pi 

\\ ii.it is electrolysis? 

[a tin- proceM of chemical decomposition of certain 

pounds in solution, BUCfa as ai ids or .salts of the rnct.il>, and al 
fusrd compounds, when a current ol" eta tin itv BOWS throui h them. 

What is meant In potential as applied to electric bodies? 

It is the difference in the positive and negative states of a body, when 

its previous state of electrical equilibrium is upset by mechanical orchem 

leal action. It is a latent force. 

Define anode, cathode, circuit, electric current, Inductive 
force, electro-motive force. 

The anode is the positive pole or wire and the cathode the negative 
pole of a battery. 

The circuit, the course of the current from the battery out and around 
the wire and hack to the battery. 

The electric current is the flow of electrical energy along the circuit. 

Inductive force is the power of an electrohed substance to act on 
adjacent unelectrotied bodies in the same manner as a magnet 

Electro-motive force is the name given to the cause of an electric flow. 
It is analogous to water pressure. The unit is the volt. It is the E. M. F. 
which will cause a current of one ampere to flow through a resistance of 
one ohm. 

Mention some conductors and some non-conductors of 
electricity and explain their behavior in connection with elec= 
trie phenomena. 

Copper, gold, silver are conductors of electricity. 

Rubber, glass, dry wood are nonconductors. 

A current of electricity flows easily over or through a good conductor, 
but as the conductivity is reduced friction occurs, and with a noncon- 
ductor no current will pa--. A strong current passing through a poor 
conductor or a very thin conductor produces heat from electrical friction. 

State method by which electricity produces (a) heat, b 
light, (c) mechanical energy. Show that electricity favors 
chemical action. 

Heat: Pass a current through a fine platinum wire. The resistance 
offered to the flow of the current produces heat. 

Light: Pass a current through a strip of carbonized bamboo in a 
vacuum. The resistance will cause the bamboo to become incandescent. 

Mechanical energy: Pass a current through the field of a motor. An 
electro-magnet is formed which draws the armatures to it, causing the 
spindle to revolve. 

Chemical action: Hydrogen and chlorine gases may be made to unite 



26 PHYSICS AND CHEMISTRY 

by the explosion of an electric spark or by electrolysis. We may disasso- 
ciate hydrogen and oxygen in water. 

Explain the method of producing Rontgen or X=rays and 
mention some of their properties and uses in medicine. 

The Rontgen or x-rays are produced in a high-vacuum glass tube when 
the cathode rays are well developed and suddenly stopped by their impact 
upon a metallic surface, such as platinum. They have the property of 
penetrating opaque bodies. They pass freely through wood, thick books, 
and plates of ebonite. Metals are more opaque than other substances, 
and bones more than flesh; hence, when exposed to these rays, they pro- 
duce shadows. They have the power to lighting up many fluorescent 
substances, and of poducing chemical action on photographic plates, as 
shown by pictures {skiagraphs) of the bony structures of animals. They 
cannot be reflected, refracted, dispersed, polarized, nor deflected by a 
magnet. 

In medicine they are used as an aid in diagnosis and for their palliative 
and curative properties upon certain diseases and growths, such as lupus, 
keloids, and malignant tumors. 

CHEMISTRY 

The subject of chemistry is divided into inorganic, organic, and physi- 
ologic for rapid and convenient reference. 

INORGANIC 

Define chemistry. 

Chemistry is the science which treats of the properties and compo- 
sition of substances, their changes in composition, and the phenomena 
attending such changes. 

Give the difference between a physical and chemical change, 
with an example of each. 

A physical change is one occurring in a mass of matter in which the 
substance retains its original properties and composition. Example: 
Water changing into ice or steam. 

A chemical change is one occurring in the molecules of matter in which 
the substance or substances lose their identity by the formation of new 
substances. 

Example: Paper when burned yields carbon dioxid (C0 2 ) and water 
(H 2 0), with some charcoal (C). 

Designate the following as chemical or physical changes: 
(a) The conversion of water into steam, (b) the souring of milk, 
(c) dissolving salt in water, (d) decay of wood, (e) decompo=> 
sition of sunlight by means of a prism. 

(a) Physical; (b) chemical; (c) physical; (d) chemical; (e) physical. 

Differentiate (a) a mass of matter, (b) a chemical compound 
and (c) an elementary body. Give an example of each. 



27 

\ mass of mattei is a n of cither el( 

pound mota ules. 

\ robld <>t' w .il it or a ^r.iin ol UUI<L 

(b) \ "..<;/ tompimtul is matter In which the molecu 
posed oi dissimilar atoms end can be simplified I 

Sodium chlorid (NaCl) oi potassium nitrate 
An elementary body (element) Is matter In srhi< h the mole i 
composed ol similar atoms end cannot be simplified. 
mfk: Hydrogen (H-H). Oxygen « I 

How many elements are there ami by what simple means arc 

thej represented? 

There are about seventy-nine elements and they are rep I by 

means oi symbols. 

Define a chemical symbol and state what it represents? 

A symbol is the initial Letter, or the initial Letter combined with some 

other letter, of the name of an element, as C for carbon, Q for chlorin. 
The symbol r e p r e s en ts the element, the atomic weight, and the 
valence of that element, as O represents oxygen, 16 parts by weight and 
the valence of 2. 

Give the symbols of the following elements: (a) gold, 
(b) silver, (c) iron, (d) arsenic, (e) potassium (kalium). 

(a) Au; (b) Ag; (c) Fe; (d) As; (e) K. 

Give the symbols of (a) antimony, (b) zinc, (c) boron, 
(d) mercury, (e) calcium. 

(a) Sb;(b)Zn;(c)B;(d)Hg;(e)Ca. 

State the chemical names of the following compounds: 
KI, CaS0 4 , HgCl 2 , FeO, NH 4 OH. 

KI, potassic iodid; CaS0 4 , calcium sulfate; HgCl 2 , mercuric chlo- 
rid; FeO, ferrous oxid; NH 4 OH, ammonic hydroxid. 

Write the chemical name of each of the following: White 
lead, gypsum, calomel, copperas, blue vitriol. 

White lead is basic plumbic carbonate. 
Gypsum is natural sulfate of calcium. 
Calomel is mercurous protochlorid. 
Copperas is ferrous sulfate. 
Blue vitriol is cupric sulfate. 

Write the chemical formulae for sodium chlorid, ferrous 
sulfate. 

NaCl and FeS0 4 respectively. 

Place after each of the following compounds its chemical 
formula: Silver chlorid, zinc sulfate, calcium oxid. 

Silver chlorid, AgCL; zince sulfate, ZnS0 4 ; calcium oxid, CaO. 



28 PHYSICS AND CHEMISTRY 

What is a radical? 

A radical is an uncombined atom. A compound radical is a chemical 
compound composed of two or more elements capable of acting as an 
element. 

Define valence, quantivalence, equivalence, atomicity, and 
give the meaning of the words monad (univalent), diad (bi- 
valent), triad (trivalent), tetrad (quadrivalent), pentad (pen- 
tivalent), and hexad (hexivalent). Give an example of each. 

Valence is the number of atoms of hydrogen which once the atomic 
weight of an element will combine with or diplace from its combinations. 

Example: Once the atomic weight (35.5 parts) of chlorin will unite 
with once the atomic weight (1 part) of hydrogen to form hydrocholoric 
acid (HC1). Valence of CI is one or monad. Once the atomic weight 
(39.1 parts) of potassium will displace once the atomic weight (1 part) 
of hydrogen from hydrochloric acid to form potassium chlorid (KC1). 

Monad, an element or group of elements having a combining power 
equal to once the atomic weight of hydrogen. Example: Chlorin as 
given above. 

A diad is equal to two atoms of hydrogen; traid to three; tetrad to four; 
pentad to five; hexad to six. 

Examples: Diad, oxygen, once the atomic weight will combine with 
twice the atomic weight of hydrogen to form water (H 2 0) ; triad, nitrogen 
as NH 3 ; tetrad, carbon as CH 4 ; pentad, phosphorus as PC1 5 ; hexad, 
Wolfram (tungsten) as WoCl 6 . In the PC1 5 and WoCl 6 the CI atoms 
represent the same number of hydrogen atoms which have been displaced 
from HC1 by once the atomic weight of P and Wo respectively. 

State the valence of the following radicals : (CN) , (HO or OH) , 
(N0 2 ), (C0 2 ), (HC). 

CN, monad; HO, monad; N0 2 , monad; C0 2 , diad; HC, triad. 

By what process are constituents of compounds obtained? 
Give examples. 

By electrolysis, as in separation of oxygen and hydrogen from water. 
By heat, as in the separation of oxygen and mercury from the red oxid 
of mercury. 

State how to obtain an atomic weight. 

1. By chemical decomposition; determining the proportion by weight 
in which the element, the atomic weight of which is unknown, combines 
with an element, the atomic weight of which is known. 

2. By means of specific weights of gases or vapors; equal volumes of 
gases contain under like conditions, the same number of molecules, and 
the molecules of elements contain (in most cases) two atoms. These 
facts give the necessary data for determination of atomic weights. For 
instance, if a certain volume of hydrogen weighs 2 grams and an equal 
volume of some other gas weighs 71 grams, the atomic weight of the latter 
is 35.5 because 2 and 71 represent the relative weights of the molecules 
of the two elements and the molecular weight divided by two gives the 
atomic weight. 



29 

B The ttomic wei | divide 

> heat oi the element. 

Distinguish between ■ itmplc molecule sod i compound 
molecule* 

A simple molecule is made up of atoms of like kind, .1 number oi then 
forming an element. 

\ compound molecule Is msde up oi atoms oi unlike kind, ■ number 
oi them being known as ■ compound. 

Define empiric, molecular, rational, anil graphic formulas, 

giving an example <>t" each. 

An cmpirii Formula is the simplest expression by formula <>f the i 
position oi a compound. It represents tin- least atomic proportions oi the 
elements composing the compound. Example: HO for hydrogen peroxid. 

\ molecular formula is that formula which expresses a quantity l>y 
weight oi a compound equal to twice its specific gravity in th< 
state compared with hydrogen. Example: HjO for water. 

A rational formula attempts to express the arrangement of the elements 
in the molecule of a compound. Example: HCjHgO, or (II,' i »< »H 
for acetic acid. 

\ ^rapliic (structural, constitutional) formula attempts to express tin- 
arrangement of the elements in the molecule of a compound by means of 
bonds. Example: 

H 

I 
H— C— H for methane, CH. 

I 
H 

Give the graphic formula of sulfuric acid, representing S as 
a diad, also as a hexad. 

H-Cfv H-O-Q/' 

H-OVJ4; H-O-O^- 

Write the graphic formula for (a) hydrogen peroxid, (b) 
ammonium chlorid, (c) mercurous chlorid, (d) ammonia, 
(e) phosphoric acid, (f) mercuric chlorid. 

ii 
H\l 
(a) H-O-O-H; (b) >X-C1; (c) Hg-Cl; 

h/ I 

II 

(d) H-N-H; (e) H-O-H^O; (f) Cl-Hg-Cl 

H-O-l 

Give the graphic formula of (a) water, (b) nitric acid, (c) 
marsh gas, (d) calcium hydrate (hvdroxid). 

H 

M) I /O-H 

(a) H-O-H; (b) H-O-XC ; (c) H-C-H; (d) Ca^ 

X) I x O-H 



30 PHYSICS AND CHEMISTRY 

Mention three acids commonly used in dentistry and give the 
specific use of each. 

Sulfuric acid — used to remove oxids from gold to enlarge small root 
canals and for pyorrhea alveolaris. 

Phosphoric acid — used in combination with oxid of zinc to form oxy- 
phosphate of zinc cement. 

Trichloracetic acid — used as an escharotic to digest fungoid pulps. 

Give the formula for (a) mercuric chlorid, (b) mercurous 
chlorid, (c) cupric nitrate, (d) zinc sulfate, (e) ferric chlorid. 

(a) HgCl 2 ; (b) HgCl; (c)Cu(N0 3 ) 2 ; (d) ZnS0 4 ; (e) FeCl 3 . 

Place the chemical formula after each of the following acids: 
Sulfuric acid, nitric acid, hydrochloric acid. 

Sulfuric acid, H 2 S0 4 . 
Nitric acid, HN0 3 . 
Hydrochloric acid, HC1. 

Give the common names of H 2 0, HN0 3 , H 2 C0 3 and N 2 0. 

H 2 0, water; HN0 3 , nitric acid; H 2 C0 3 , carbonic acid; N 2 0, hypo- 
nitrous oxid, nitrous oxid or laughing gas. 

Give the chemical composition by formula of each of the 
following: (a) lunar caustic, (b) green vitriol, (c) muriatic 
acid, (d) caustic potash (kali caustic), (e) carbonic acid gas, 
(f) caustic soda (natri caustic). 

(a) AgN0 3 ;(b) FeS0 4 ; (c) HC1; (d) KOH; (e) C0 2 ; (f) NaOH. 

Give the chemical name and formula of (a) common table 
salt, (b) marble, (c) plaster of Paris, (d) borax, (e) blue vitriol, 
(f) soot, (g) vinegar, (h) verdigris. 

(a) Sodium chlorid, NaCl; (b) calcium carbonate, CaC0 3 ; (c) anhy- 
drous calcium sulfate, CaS0 4 ; (d) sodium biborate, Na 2 B 4 7 + ioH 2 0; 
(e) cupric sulfate, CuS0 4 + 5N 2 0; (f) carbon, C; (g) dilute acetic acid, 
HC 2 H 3 2 ; (h) basic cupric acetate, Cu(C 2 H 3 2 ) 2 Cu(OH) 2 +5H 2 0, is 
the approximate composition. 

What is an ion? Give example. 

An ion is an electrically charged element or group of elements. 

Example: When sodium chlorid is dissolved in water it is partially 
dissociated into ions of sodium and chlorin. NH 4 C1 heated to a high tem- 
perature dissociates into ions of NH 3 and HC1. 

How many forms of ions? 

There are two forms: cations ( + ), those elements or group of elements 
which carry cationic electric charges and are attracted to the cathode 
or negative pole of an electric battery, and anions (— ), those which carry 
anionic electric charges and are attracted to the anode or positive pole. 

By what symbols are cations and anions designated? 



itom* wughi 

( '.iii..:- -nated by 1 ' . and ai. 

dash oi .- eai li dot oi dash r»j »r 

■ .■ l', potassium, monad cation; Ba", barium, diad cation; 

(T. Chloiin, monad anion; V", nitrogen, tn.nl anion. 



Stats the atomic theory . 

Matu-r is composed of minute parti< lea, i ailed motet ul< , and ea< h of 
molecules is made uj) oi smaller, indivisible particles, called . 
which a< cording to fixed laws unite with ea< h other in definite proportions 
by weight 

Describe a method of obtaining specific gravity of liquids 

and gases. 

The specific gravity of liquids may be determined by a hydrometer 
or by weighing s glass flask, first empty and then full of water and then 
full oi tin- Liquid in question. Divide the weight of the liquid by the * 
of the water and the result will be the specific gravity. Gases may be 
determined in the same manner by exhausting the air in the bottle, weigh- 
ing it, tilling with air, and weighing it, and finally weighing the bottle tilled 
with gas. Divide the weight of the gas by the weight of the air, and the 
result will be the specific gravity. 

Give the name and atomic weight of each of the following: 
Ca, Al, Ni, P, Pt. 

Ca, calcium, 39.7; Al, aluminum, 26.9; Ni, nickel, 58.6;?, phosphorus, 
31 ;Pt, platinum, 19.7. 

Define atomic weight and equivalent weight. Give an 
example of each. 

Atomic weight is the specific gravity of an element in its gaseous state, 
compared with hydrogen — except mercury, cadmium, helium, and argon, 
the atomic weight of which Is twice the specific gravity, and arsenic and 
phosphorus, the atomic weight of which is one-half the specific gravity. 

(b) The atomic weight of an element is that weight which, when mul- 
tiplied by the specific heat of the element, yields a product of about 6.4. 
Example: The specific gravity of oxygen is 16, compared with hydrogen. 
If the specific heat of oxygen (0.4) be multiplied by 16, it will yield a 
product of about 6.4; therefore 16 is the atomic weight of oxygen. 

(c) Atomic weight is the smallest quantity by weight of an element 
that is present in the molecute of any of its compounds. Example: The 
smallest quantity of chlorin present in a molecule of sodium chlorid, or 
in a molecule of hydrochloric acid, is 35.5 parts by weight, therefore 35.5 
is the atomic weight of chlorin. 

Equivalent weight is the least weight of an element that will combine 
with, or displace 1 part by weight of hydrogen. Example: Water. 
H 2 0, contains 2 parts by weight of hydrogen and 16 parts by weight of 
oxygen; therefore 1 part by weight of hydrogen is combined with 8 parts 
by weight of oxygen, consequently 8 is the equivalent weight of oxygen. 

Define molecular weight and molecular volume, giving an 
example of each. 



32 PHYSICS AND CHEMISTRY 

The molecular weight of an element or compound is equal to twice its 
specific gravity in the gaseous state compared with hydrogen; or, it is 
the sum of the atomic weights of the elements contained in a molecule 
of a substance. Example: 2 , molecular weight 32; H 2 S0 4 , = o8. 

Molecular volume is the volume occupied by once the molecular weight 
of an element or compound in its gaseous state compared with hydrogen. 
Example: 

32 gm. of O =22.32 liters (22,320 cc.) 

18 gm. of H 2 = 22.32 liters (22,320 cc.) 

2 gm. of H =22,32 liters (22,320 cc.) 

Define (a) an atom, (b) a molecule, (c) a mechanical mix= 
ture, and (d) a chemical compound. 

(a) An atom is, theoretically, the smallest particle of matter that can 
exist only in chemical combination. 

(b) A molecule is, theoretically, the smallest particle of matter that can 
exist alone. 

(c) A mechanical mixture consists of two or more substances each of 
which retains its individual characteristics and may be separated from 
the others by mechanical means. 

(d) See page 27, first question, (b). 

Define chemical affinity (chemical force, or attraction 
chemism), and give an example. 

It is the affinity or attraction which exists between the atoms of certain 
substances acting through inappreciable distances to form new com- 
pounds. Example: 

H + Cl =HC1. 

HCI+NH3 =NH 4 C1. 

Define chemical affinity and state how it differs from other 
forces. 

Chemical affinity is the attraction between unlike atoms, the combin- 
ing of which forms new substances and in combining produces heat 
All physical forces act without the molecule while chemical affinity acts 
within the molecule. 

By what principle do elements combine to form compounds? 

Elements combine according to the law of chemical affinity, atoms or 
ions of unlike electrical potential combining. 

State the law of Avogardo and explain its relation to modern 
chemistry. 

Equal volumes of different gases contain, under identical conditions, 
the same number of molecules. 

This law is of value in determining the molecular weight of gases, the 
molecular formula and the atomic weight of elementary gases. 

What are the laws governing combination of elements? 

1. All chemical compounds are definite in their composition; the 
ratio of the elements forming chemical compounds is constant. 



( 111 ML \I R] \. ! : 

Oth« in D 

'. ill be multipl 

I he proportion by weight in which a: 

with a third el nts that p a in which they would unite 

with ^ 'inc. 

Write the equation showing the reaction of sulfuric acid 
on common sail. State a general theorj to this particular 
reactiorit 

H,S< I v ' ' • ;,'(!. 

When I al compounds are brought in i u h other, 

the elements of one having an affinity n>r tin- elements of the oth< 
combine ami form new chemical compounds. 

Show In equation how nitric acid is formed by the action of 
sulfuric acid on potassium nitrate. Mow is nitric acid 
tinguished from the other mineral acids? 

2KNO,OH 4 +SO,-2HNO,h K 4 S< 

Nitric acid is the only mineral acid which forms a bluish-green liquid 
when dropped on a sheet of copper. 

What is water of crystallization? 

It is a form of water incorporated in certain substances which c; 
them to assume crvstaloidal shapes and sometimes influencing their i 

State the conditions favorable to crystallization? 

The substance must be in a fluid or semi-fluid state that the mole* 
may move freely to form the characteristic crystals upon returning to 
'lid state. A solid to be crystalline must be heated to fluidity 
and allowed to cool slowly or dissolved in a solvent and the solvent 

evaporated. 

What physical forces have a tendency to decompose com- 
pound substances? Give examples. 

Heat: As in decomposition of the red oxid of mercury into the metal 
and oxygen. 

Light: As demonstrated in the photographic art. 

Electricity: As demonstrated by electrolysis of water producing 
hydrogen and oxygen gases. 

Describe destructive distillation and describe the gi 
formed during that process. 

Destructive distillation is the reduction of a complex substance to 
complex or simpler substances by means of heat and in a closed retort. 
The nature of the products formed varies not only with the nature of 
substances heated, but with the temperature applied during the open 
Soft coal being subjected to dry or destructive distillation gi' 
gases such as nitrogen, marsh gas, carbon monoxid, and dioxid, and 
hydrogen. 
3 



34 PHYSICS AND CHEMISTRY 

Differentiate between oxidizing and reducing agents. 

An oxidizing agent is one which parts with its oxygen to unite and 
combine with other substances to form oxides; thus, if potassium nitrate 
is added to the metal copper and heat applied, copper oxide and potas- 
sium nitrate is formed. 

A reducing agent is one that has the power of extracting oxygen from 
an oxide; thus: CuO + 2H=H 2 + Cu. 

Define absorption and diffusion. 

Absorption is the taking up and retaining of one substance by another 
without material increase in size or the receiving of light or heat rays 
by a substance. 

Diffusion is the gradual intermixing of liquids or gases of different 
density when carefully placed in a single vessel. 

Explain an experiment to prove that chemical action may 
be induced by light, also by electricity. 

A mixture of equal volumes of H and CI placed in the direct rays of 
the sun causes the chemical affinity between them to exert itself with 
explosion and the production of HC1, hydrochloric acid. 

If a mixture of two volumes of H and one volume of O be placed in 
a strong glass tube containing two platinum electrodes which are con- 
nected with an induction coil, and a spark of electricity be passed through 
the mixture, the chemical attraction between them exerts itself with the 
formation of H 2 0, water. 

Describe the chemical process (a) when iron rusts, (b) when 
wood burns, (c) when silver is tarnished by coal gas. 

(a) Oxygen in the presence of moisture oxidizes the iron with the for- 
mation of Fe 2 3 , ferric oxid. 

(b) Wood, which is composed of C, H, and O, when burned produces 
C0 2 and H 2 0, with a residue of some charcoal when not completely de- 
composed. 

(c) A black coating of silver sulfid, Ag 2 S, forms on silver exposed to 
coal gas, due to the presence in the coal gas of H 2 S, hydrogen sulfid. 

What is oxidation? Give an example. 

Oxidation is the union of oxygen with other substances. Example: 
See preceding question, (a) and (b). 

What is combustion? Give the chemical cause of spon= 
taneous combustion. 

Combustion is rapid oxidation with the evolution of heat and light. 

Spontaneous combustion may be due to very active oxidation of certain 
substances in a very finely comminuted state, as occurs when finely divided 
phosphorus is exposed to the air or oxygen. It may be caused by direct 
chemical union, as occurs when pulverized antimony or arsenic are thrown 
into a vessel filled with dry chlorin gas. It may be due to hydration, 
as when lime combines with moisture, or to dehydration, as when strong 
sulfuric acid acts upon wood. 



1 ! : 

Describe two experiments showing the difference between 
mechanical and chemical action. 

t:. Add BUgai U) w.itct ; il disappear 

lng into solution and yieldij . particle of the 

boc sweetness; undergoing do < bemi< al « bange, but .t phi ^i< al i 

.7.1. :ion.— Sugar treated w ith sulfuric a< id undergoes i bemi( .il 
change and is converted into charcoal and water, forming ■ black liquid 
without the characteristic sweetness of sugar. 

Into what two principal groups are elements divided? De- 
fine positive and negative elements, giving examples ol each* 

Into metals (positive) and metalloids or Qon-metals (negativi 
A positive dement i> one which is attracted to the negative p«>l«- 
electric battery when a compound i.> electrolyzed. Example: Hydi 
sodium, gold. 

A N I lenient is one which separates at the positive pole when 

an electric current is conducted through a com])ound. Example: 
Chlorin, oxygen, iodin. 

Explain the difference between metals and non-metals. 

Metals are solid substances at ordinary temperature (except mercury), 
opaque, with more or less metallic luster, malleable, ductile and tenacious. 

They conduct well both heat and electricity and are electropositive, 
capable oi forming basic substances and salts. Those elements which 
do not possess most of these properties are classed as non-metals. 

Write the chemical name of each of the following: Muriatic 
acid, quick lime, salt, cinnabar, Epsom salts. 

Muriatic acid is hydrochloric acid or hydrogen chlorid. 

Quick lime is calcium oxid. 

Salt (common) is sodium chlorid. 

Cinnabar is mercuric sulfid. 

Epsom salts is magnesium sulfate. 

Define negative elements, positive elements. Mention the 
conditions under which negative and positive elements act on 
each other. Illustrate this action. 

When a substance is split up by the process of electrolysis, the nega- 
tive ions of a negative element are found at the positive pole; the positive- 
ions at the negative pole. 

Electro-negative elements combine with oxygen to form acids. 
Electro-positive elements combine with oxygen to form basic oxids. 
They combine when brought together in the atomic state. 
Electro-positives are: Electro-negatives are: 

Hvdrogcn Oxygen 

Metals Halogens (CI, Br, I, F) 

Bases and basic radicals Acids and acid radicals 

Explain the term alkali and concisely state its properties. 

Alkali is a substance having the strongest basic (electro- positive) 
properties, usually referring to the oxids and hydroxids of the alkali 
metals and metals of the alkali earths. Such substances are very solu- 



36 PHYSICS AND CHEMISTRY 

ble in water; change red litmus to blue; unite with and neutralize acids, 
forming salts, and emulsify fats. 

How does each of the following affect litmus paper: (a) H 2 0, 
(b) H 2 S0 4 , (c) NH 4 OH, (d) NaHC0 3 ? 

(a) No effect; (b) changes it to red; (c) and (d) turn it blue. 

Give the names of two elements in each of the following 
groups: (a) Univalent, (b) bivalent, (c) trivalent, (d) quad= 
rivalent. 

(a) Hydrogen, chlorin; (b) oxygen, barium; (c) nitrogen, phosphorus; 
(d) carbon, platinum. 

Define and give illustrations of allotropism (allotropy). 

Allotropism ("a turn or change") the property possessed by certain 
elements of presenting themselves in two or more different forms, which 
may differ in their physiologic action. Example: The allotropic, forms 
of carbon are: diamond, graphite, and charcoal; of phosphorus: yellow, 
white, red, and black. All the varieties of phosphorus are toxic except 
the red. 

Name and define the laws governing chemical combination 
of elements. Give examples. 

1. Law of Constant or Definite Proportion. — The same compound is 
always composed of the same elements in constant proportions by weight. 
Example: NaCl, sodium chlorid, is composed of 23 parts by weight of 
Na and 35.5 parts of CI. 

2. Law of Multiple Proportions {Ratio). — When two elements unite in 
several different proportions, the weight of one is constant and the weight 
of the other varies according to a simple multiple ratio. 

Example: 

H o 

H 2 =2 16 parts by weight. 

H 2 2 = 2 32 parts by weight. 

Hg CI 

HgCl = 200 35.5 parts by weight. 
HgCl 2 =200 71 parts by weight. 

3. Law of Equivalent Proportions or Reciprocal Proportions. — The 
weights of different elements which combine separately with one and the 
same weight of another element, are either the same or are simple multiples 
of the weights of these different elements which combine with each other. 
Example: 

H, 1 part by weight, unites with CI, 35.5 parts by weight. 
H, 1 part by weight, unites with O, 8 parts by weight. 
Then the porportions by weight in which CI and O would unite 
would be as 35.5 is to 8. 

4. Law of Gaseous Volume (Gay Lussac's Law.) — When chemical 
action takes place between gases, either elements or compounds, the volume 
of the gaseous product bears a simple relation to the volumes of the 
reacting gases. Example: H, n. 16 liters, unites with CI, n. 16 liters, 
to form HC1, 22.32 liters. 



A( II 'Ml 

Define t.i isomerism, h; metamerism, , p. »l\ nurism, and 
glVQ an example of e.'u h. 

(,u / i Compounds which contain we same elements is 

same relative proportions by weight in tin- molecule, i>ut < ii u « 
leu widely in their physical, chemical, and phj propertii 

called Example: C, n.. Is the molecular 

formula for oil of lemon, turpentine an. I a number of other ofla. 

(h) lietami rism.— Com pounds having tin- same pen entage < omj 
don aiul the same molecular formula an- (.died meta m er ic t metaim 
or metamers. Example: See example under isomerism. 

Polymeri$m.~--Coinpound8 posses ing the Bame pep com- 

position, but different molecular formulas an- termed po lym er ic , pdy~ 
meridSj or polymers. Example: 

(II < >. Formaldehyd. 

C..H ,< ).,, \« etic acid. 

('.,1 1. Lactic add. 

C e II 12 O e , (.lucose. 

Define and illustrate the terms: (a) acids, (b) bases, (c) 
salts. 

(a) Acids are compounds having electro-negative or anionic properties 
and containing hydrogen, which is replaceable by metals to form salts. 
They change blue litmus to red. Examples: I KM, II 2 S0 4 . 

(b) Bases are the oxids or hydroxids of metals, especially of the alkali 
and alkali earth metals, having electropositive or cationic properties. 
When in solution they neutralize acids, forming salts and water. They 
emulsify fats and change red litmus to blue. 

(c) Salts are compounds composed of a positive element or radical 
united with a negative element or radical. They are formed in five ways: 

i. By the union of a metal (+) and a non-metal (— ). 
Na+Cl=NaCl. 

2. By the union of a basic oxid ( + ) and an acidic oxid (— ). 

CaO + C0 2 =CaC0 3 . 

3. By the union of a base ( + ) or basic radical and an acid (— ). 

NaOH+HCl = NaCl + H 2 0. 
NH 3 +HC1=XH 4 C1. 

4. By the action of a metal on an acid. 

Zn + H,S0 4 = ZnS0 4 + H 2 . 

5. By the substitution of one radical for another. 

XaCM-f AgN0 3 =NaX0 3 +AgCl. 

What is a (a) normal salt, (b) an acid salt, (c) a double 
salt? Give an example of each. 

(a) A normal salt is one in which all the H of an acid is replaced by 
a metal or basic radical. Example: Xa 2 S0 4 . 

(b) An acid salt is one in which only part of the H of an acid is replaced 
by a metal or basic radical. Example: XaHS0 4 , acid sodium sulfate 
(bisulfate); XaHC0 3 , acid sodium carbonate (bicarbonate). 

(c) A double salt is a combination of two salts. Example: (KCM) 2 - 
PtCl 4 , potassioplatinic chlorid; K 2 S0 4 A1 2 (S0J 3 potassio-aluminic sulfate 
(alum). 



38 PHYSICS AND CHEMISTRY 

Classify the following as acids, bases and salts: Ag 2 0, HC1, 
AgN0 3 , NaS0 4 , H 2 S0 4 , H 2 C0 3 , CaO, NaOH,K 3 P0 4 . 

HC1, H 2 S0 4 , K 3 P0 4 are acids. 
Ag 2 0, CaO, NaOH are bases. 
NaS0 4 , H 2 C0 3 , AgN0 3 are salts. 

Give the chemical nomenclature of (a) salts and (b) acids, 
with examples. 

(a) The positive element or radical of a salt is named first, and then the 
negative element, which terminates in "id" in simple salts and "tie" and 
"ate" in the case of oxysalts. Examples: BaCl 2 , barium chlorid; Na 2 S0 3 
sodium sulfite; Na 2 S0 1 , sodium sulfate. 

(b) In the case of hydrogen acids "hydro" is prefixed to the negative 
element, which terminates in "ic"; or the suffix "hydric" may be attached 
to the negative element. Example: HC1, hydrochloric or chlorohydric 
acid. 

Oxyacids are named according to the acidic oxids (anhydrids) to which 
they correspond. Example: H 2 S0 4 , sulfuric acid, corresponds to S0 3 , 
sulfuric oxid; H 2 S0 3 , sulfurous acid, corresponds to S0 2 , sulfurous oxid. 

Explain the significance of the prefixes: hydro, hypo, hyper, 
sub, bi, nitro, proto, sesqui ; and the suffixes (affixes) : ous, ic, 
ite, ate, and id. 

Hydro indicates a compound containing hydrogen combined with 
another element, as hydrochloric acid. 

Hypo is prefixed to a compound containing less of the negative ele- 
ment, oxygen, than the ous compound in that series, as hyposulfurous 
acid. 

Hyper (per) indicates that the compound contains a greater amount of 
oxygen than the ic compound in the series, as hyperchloric oxid. 

Sub designates a combination of two atoms of the positive element with 
one atom of the negative element, as Ag 2 0, suboxid of silver; K 2 S, potas- 
sium subsulfid. 

Bi represents a combination of one atom of the positive element with 
two atoms of the negative element, as HgCl 2 , mercury bichlorid. 

Nitro indicates the presence of the N0 2 radical in a compound, as 
C 3 H 2 (N O 2 ) 3 ( OH) 3 , trinitroglycerin. 

Proto (mono) refers to a combination of one atom of the positive ele- 
ment with one atom of the negative element, as NaCl, sodium chlorid. 

Sesqui is a combination of two atoms of the positive element with three 
atoms of the negative element, as Fe 2 3 , iron sesquioxid. 

The suffix ous indicates that a compound contains less, and the suffix ic 
that it contains more, of the other or electronegative element, as HgCl, 
mercurous chlorid ; HgCl 2 , mercuric chlorid. A compound ending in "ic" 
is also the most stable compound in a series. 

The suffixes ite and ate indicate an oxysalt; ite is used when the salt is 
produced from an oxyacid terminating in ous; and ate, when the acid 
terminates in ic, as Na 2 S0 3 , sodium sulfite. Na 2 S0 4 , sodium sulfate. 

The term id indicates a simple salt, as KI, potassium iodid. 

What is the difference between two acids composed of the 



39 

same elements, the name of the one ending In M om H and 1 1 1 . • r 
of the other In '•Ic**? Illustrate bj giving name and formti 

An "ii " add la more stable end produces en ' 

important salts have "ate" as .m ending. 

An M ous" .n id i ontains . i",,rrn " [l 

Nitric add ll\»>,. sulphuric add 11 
Nitrous add HNOy sulphurous add I 

Mention and uiNc formula of three acids used In medicine. 
Acetic add, lH'di/),; sulphuric add, ELS0 4 ; bydrochloi 

Hl'l. 

Define anhydrous, alkaline, neutral. 
An anhydrous Bubstance is one deprived o! water. Plaster of Paj 
anhydrous sulfate of calcium. 

An alkaline substance 18 One which turns red litmus blue, unites with 

and neutralizes acids, forms salts and emulsifies Pats. 

Neutral expresses the condition of a substance when it will not change 
either red or blue litmus and has no alkaline or acid properti 

Place the chemical formula after each of the following: 
Hydrogen sulfid, potassium iodid, calcium sulfite, magnesium 
carbonate, and mercuric chlorid. 

Hydrogen sulfid, H 2 S; potassium iodid, KI; calcium sulfite, CaS0 3 ; 
magnesium carbonate, MgCO,; mercuric chlorid, HgCL. 

Explain the difference between a sulfate and a sulfite, and 
give an example of each. 

A sulfate is an oxvsalt in which the hydrogen of sulfuric acid has been 
partly or wholly replaced by a metal or basic radical. The molecule of 
a sulfate contains the acidulous radical S0 4 . Examples: NaHS0 4 , 
sodium acid sulfate or bisulfate; Xa 2 S0 4 , sodium sulfate. 

A sulfite is an oxvsalt in which the hydrogen of sulfurous acid has been 
partly or wholly replaced by a metal or basic radical. Its molecule con- 
tains the acidulous radical S0 3 . Examples: XaHS0 3 , sodium acid sulfite 
or bisulfite; Na 2 S0 3 , sodium sulfite. 

What is the essential element of all acids? Differentiate 
between hydracids and oxyacids. 

Hydrogen is the essential element. Hydracids (hydrogen acids) are 
compounds composed of hydrogen and a non-metallic element, except 
oxygen, as HC1, H 3 As, hydro-arsenic acid. 

Oxyacids are the hydrates of acidic oxids, ternary compounds contain- 
ing hydrogen, oxygen, and another element, as H 2 S0 4 , from S0 3 — H 2 0. 

Explain the terms (a) solution, (b) precipitate, (c) incom- 
patible, (d) nascent state, (e) alloy, (f) amalgam. 

(a) A liquid in which is dissolved a solid, liquid, or gaseous substance. 

(b) A solid substance thrown out of solution by chemical action. 

(c) Substances which, when brought together, result in a precipitate, 



40 PHYSICS AND CHEMISTRY 

or produce a poisonous, inflammable or explosive substance or otherwise 
modify their individual characteristic properties. 

(d) Nascent state ("nascere," to be born) refers to the moment of 
liberation of an element or group of elements from its compounds. 

(e) Alloy means a mixture of two or more metals, as Cu and Zn to 
form brass. 

(f) An amalgam is an alloy containing mercury, as tin and mercury. 

What is meant by chemical reaction? 

"Chemical reaction in its broader sense refers to any chemical change, 
but is used more especially when the intention is to study the nature of the 
substance decomposed or formed" (Simon). 

Define lixiviation. 

Lixiviation is the process of washing porous substances to dissolve out 
certain salts; for instance, wood ashes to remove potassium carbonate. 

Define crystalline structure, nascent state. 

By crystalline structure is meant that the molecules of a substance 
assume definite geometrical forms or designs. 

A substance is said to be "nascent," or "in the nascent state," when 
its atoms are free and not combined to form molecules. 

What is a chemical reagent? 

A substance which, when brought in contact with another substance, 
produces some new substances, the chemical action manifesting itself 
by a coloration or the formation of a precipitate. 

Define qualitative and quantitative analysis. Illustrate each. 

Qualitative analysis determines the constitutents of a body or a com- 
pound by forming with each constituent a compound of a different charac- 
ter. Example: A solution of silver nitrate treated with hydrochloric acid 
yields a white precipitate of silver chlorid. The ions of silver unite with 
the ions of chlorin and precipitate; the hydrogen ions and the nitric acid 
radical, N0 3 , unite to form nitric acid which is held in solution; then 
more ionization occurs and the process is repeated. 

Quantitative analysis determines the quantity of the constituents in 
a body or compound by various means. Example: The resulting pre- 
cipitate of silver chlorid, obtained from a solution of silver nitrate treated 
with an excess of hydrochloric acid, washed, dried, and weighed and the 
quantity of silver present in the silver nitrate calculated from the weight 
of the silver chlorid. 

What is the difference between analytic and synthetic methods 
in chemistry? Illustrate each. 

Analytic methods split a compound into a simpler compound or its 
elements. Example: Heating HgO yields Hg+ O. 

Synthetic methods build up from simpler substances more complex 
bodies. Examples: Heating metallic copper in the air yields cupric 
oxid. 



I 111 UK \l I Ql \ 1 : 

Qlvc the flame test tor barium, strontium, and calcium. 
\ i lean platinum wire, moistened with hydrochloric add and o 

with the metal dthel in powder form <>r in Solution, when ln-l<l ... 

Bunsen burner, Imparta t<> the Same a yrilir, . « « »i « > r in the < as< () f 

barium; s briiUmi ted in tin- case of strontium, and .1 yellowish r<<i in the 

.ili i 11 in . 

in a solution containing calcium and maraaslum hon would 
you separate ami distinguish the two metals? 

The addition of \ll,ci. Ml.oll and (NH 4 I pre I \ the 
calcium, which imparts to the Same of ;i Bunsen burner ;i yet 
color. It" the solution is filtered and tin- filtrate evaporated to ■ small 
volume, the addition of N 1 1 x ( >l I and .sodium hydrogen phosphate i 
a white precipitate of magnesium ammonium phosphate, indicating the 
presence of magnesium. 

Define a reaction and an equation. 

A reaction is the chemical change which occurs when two or more sub- 
stances are brought together. 

An equation is the represention of the chemical change occurring in a 
reaction by means of symbols and formulas. 

In what condition are elements generally found in nature? 
Mention two exceptions. 

Klements are usually found in combination with other elements 
in the form of chemical compounds. 

Oxygen in air, carbon, as the diamond and in some instances gold 
is found in its elementary form. 

Mention four compounds, giving the formula and molecular 
weight of each. 

Water, H 2 0, molecular weight 18; nitric aicd, HN0 3 , molecular 
weight 63; sulphuric acid, H 2 S0 4 , molecular weight 98; and carbon 
dioxid CO,, molecular weight 44. 

Complete the following equation and write the name of the 
resulting compounds. 

C 2 HC1 3 + KOH = KCHO, + CHC1 3 

Potassium formate. Chloroform. 

Indicate by an equation the reaction of zinc and hydro- 
chloric acid. 

Zn 2 + 4 HCl=2ZnCl 2 +HX0 3 . 

Complete the following equations and write the name of each 
resulting compound under its formula: 



(a) As 2 3 


+ 3 H 2 S 


— 




H 2 S0 4 


+ NaNO, 


= 




As 2 3 


+ 3 H 2 S 


= As,S, 


+ 3H 2 






Arsenious sulfid. 


Water. 



H 2 S0 4 +NaN0 3 - NaHSO, + HNO,. 

Sodium hydrogen sulfate. Nitric acid. 



4 2 



PHYSICS AND CHEMISTRY 



(b) HgSO, 
FeSO, 
HgSO, 

FeSO, 



H 2 



(<=) 



Water. 

C 2 HC1 3 

Pb(N0 3 ) 2 
C 2 HC1 3 

Chloral. 



+ Hg + 
+ 2 NaHCO, 
+ Hg + * 

+ 2 XaHCO, 

+ C0 2 . 

Carbon dioxid. 

+ NaOH 
+ K 2 CrO 
+ NaOH 



2 NaCl 



2NaCl 



2 HgCl + 

Calomel. 

FeC0 2 -f 

Ferrous carbonate. 



Na 2 S0 4 . 

Sodium sulfate. 

Xa 2 S0 4 + 

Sodium sulfate. 



CHCI3 

Chloroform. 



(Note: KOH yields similar results.) 



Pb(N0 3 ) 2 

(d) Ca(OH) 2 
NaC,H 3 0. 
Ca(OH) 2 

NaC 2 H 3 2 



+ 

+ 
+ 
+ 



K 2 Cr0 4 



C0 2 

NaOH 

C0 2 



- PbCr0 4 

Plumbic chromate. 



= CaC0 3 + 

Calcium carbonate. 



+ NaOH = 



NaCH0 2 . 

Sodium formate. 



2KN0 3 . 

Potassium nitrate. 



H 2 0. 

Water. 

Na 2 CO. 



CH 4 + 

Methane. Sodium carbonate. 



(e) 2 NaCl + Ag 2 S0 4 



(0 



(g) 



(h) 



Ba0 4 + 
2NaCl + 

BaOo + 



C0 2 + 

Ag 2 S0 4 

CO, + 



H 2 



= 2AgCl + Na 2 S0 4 . 

Argentic chlorid. Sodium sulfate. 

H 2 0= BaC0 3 + H 2 2 . 

Barium carbonate. Hydrogen peroxid or dioxid. 



C 2 H 5 C1 + AgOH = 
Sb 2 S 3 + 6HC1 = 
C 2 H 3 C1 + AgOH = 


AgCl + C 2 H 5 OH. 

Argentic chlorid. Alcohol (Ethyl). 


Sb 2 S 3 + 6HC1 = 


2 SbCl 3 + 3 H 2 S. 

Antimony chlorid. Hydrogen sulfid 


2 C 2 H 3 O.OK + H 2 S0 4 
2 C 2 H 3 O.OK + H 2 S0 4 = 

Potassium acetate. 


K 3 SO + 2HC 2 H 3 2 or 

Potassium sulfate. Acetic acid. 


2 C 2 H 3 O.OH. 




2 NaCl + H 2 S0 4 = 
CaC0 3 + 2HCI = 
2 NaCl + H 2 S0 4 = 


Na 2 S0 4 + 2HCL 



Sodium sulfate. Hydrochloric acid. 



CaCO, 4- 2HCI = CaCL 



Calcium chlorid. 



H 2 + 

Water. Carbon dioxid. 



CO, 



(i) MgCl, 
C 2 H 5 OH 
MgCl 2 



NH 4 C1 



C 9 H ; 



NH 4 C1 



HS0 4 
+ 



Na a HPO : 



Na 2 HP0 4 = 



MgNH 4 P0 4 

Magnesium ammonium 
phosphate. 



2 NaCl + HC1. 

Sodium chlorid. Hydrochloric acid. 



( 1(1 UIi \1 I Q| \ 1 . 

en OH < mi - (Cfi 

(k) Cal'l, ■ \ . « - I 

Ml.oll - 
( A( i. \, CO, - 

FcCl ;XH 4 OII I e OH . Mi, 

(1) (Ml OH XaC H,0, II SO, - 

: I I »\ II + 2ll « » 

C II I 'II \,.( II ' ». II S< •. 

( II. I H t O, 4- vmm), . ii 

Eth\ . :m hydrogen sulfate. LttC 

CO XII. \. or COXMI, or CH 4 N,0 (NHJjCO* 



L'rc.i. 


Urea. Ammonium carbonate. 


(m) P( 1 + 3H,0 

CH.COONa + NaOH 

pa, + 3 H,0 

Phosi>horous chlorid. 

CH,COONa + Na< 'II 

Sodium mu 


1I.PO, - MCI. 

Phosphorous acid. rochlonc acid 

CH 4 4- Na,CO r 

Methane. Sodium carbonate. 


(n) BaO, + H,S0 4 = 

BaO, 4- H" 2 S0 4 = BaS0 4 4- H,0,. 

Barium sulfate. Hydrogen d'ioxid. 


Complete the following chemical equations: 

(i) FeSO, 4- K 2 C0 3 = 

(2) Ca(OH), 4- 2HgCl 

(3) Pb(X0 3 j 2 + 2KI 


(i) FeS0 4 4- K,C0 3 

(2) Ca(OH), 4- 2HgCl 

(3) Pb(N0 3 ) 2 4- 2KI 


= FeC0 3 + K S0 4 . 

= Hg,0 4- CaCl, 4- H,0. 

= PbI 2 4- 2KNO t . 



Give the common names for zinc sulfate, copper sulfate, 
aluminum oxid. 

Zinc sulfate = White vitriol. 

Copper sulfate = Blue vitriol. 
Aluminum oxid = corundum. 

Write the formula for ammonium hydrate and potassium 
nitrate. 

NH 4 OH and KX T 3 respectively. 

Complete the following equations: CuO + HoS0 4 ; AgNO.- 
NaCl. 

CuO 4-H,S0 4 = CuS0 4 4- H,0 
AgNO 3 4- Nad = AgCl 4- XaX0 3 

What reaction takes place when chloral hydrate is mixed 
(heated) with an alkali? Illustrate by equation. 



44 PHYSICS AND CHEMISTRY 

The production of chloroform, a formate of the alkali metal, and 
water. 

C 2 HC1 3 0H 2 + KOH = CHCI3 + KCOOH + H 2 0. 

Chloral hydrate. Chloroform. Potassium formate. Water. 

What is the chemical antidote in case of poison by tartar 
emetic? 

Tannic acid. 

Explain the reaction which occurs when the aqueous solu= 
tions of the two parts of a Seidlitz powder are mixed. 

The tartaric acid and sodium bicarbonate present react upon each 
other, producing sodium hydrogen tartrate, water, and carbon dioxid, 
as shown by the following equation: 

KNaC 4 H 4 6 + NaHC0 8 + H 2 C 4 H 4 6 = 

Rochelle salt. Sodium bicarbonate. Tartaric acid. 

KNaC 4 H 4 6 + NaHC 4 H 4 6 + C0 2 + H 2 0. 

Sodium hydrogen tartrate. 

Composition of Seidlitz powder: The blue paper contains Rochelle 
salt, 120 gr. (7.8 gm.), and sodium bicarbonate, 40 gr. (2.6 gm.). The 
white paper contains tartaric acid, 35 gr. (2.3 gm.). 

What does H 2 2 represent? 

Two atoms of hydrogen combined with two atoms of oxygen to form 
one molecule of hydrogen dioxid, molecular w r eight 34. 

What is meant by H 2 S0 4 ? 

Two atoms of hydrogen, one of sulfur and four of oxygen chemically 
combined to form one molecule of sulfuric acid w T ith a molecular weight 
of 98. 

Find the weight and the volume of hydrogen contained in 
17 grams of NH 3 . 

Seventeen grams of NH 3 represents 14 gm. of N and 3 gm. of H. 
One gram of hydrogen under standard temperature and pressure occupies 
a volume of n. 16 liters, therefore 3 gm. of hydrogen would measure 
3X 11.16 liters =33.48 liters. 

Calculate the per cent, of each constituent present in sulfuric 
acid (atomic weight of sulfur, 32). 

H 2 S0 4 is the molecular composition of sulfuric acid, which represents 
2 parts of hydrogen, 32 parts of sulfur and 64 (4X 16) parts of oxygen 
by weight. 

Therefore, the molecular weight of sulfuric acid would be 2 + 32 + 64 = 
98; hence, 100 parts (per cent.) would be found by the following calcu- 
lations: 



98 : 100 : 
98 : 100 : 
98 : 100 : 



2 : x = 2.04+ per cent, hydrogen. 
32 : x = 32.65+ per cent, sulfur. 
64 : x = 65.30+ per cent, oxygen. 



SYDIO .;5 

What is the pUffCttlt U f f composition of \a\'() ? 

N'a ;• |ht 

\ i \ parts \<\ weight. 

I I ;lit. 

molecular wd 

: ioo : iit. sodium. 

: ioo : : i j x 
; : ioo : : 4S : .v 5(1. 17 • per < mi. oxygen. 

Ton grains of pure BOdlum h\dro\id is dissolved in water, 
a How much nitric acid must be added to make- the- solu- 
tion neutral? 

b How much BOdiuiTJ nitrate would he obtained it thli 
should be done? 

150 cc of nitric arid. 
tj>) 2i ;- grams of sodium nitrate. 

Find the number of grains of water required to yield 40 

prams of H. 

Water, I l.o atomic weight of H is 1 while the atomic weight of 
Oxygen IS 16; therefore, the molecular weight of JI..O is 18. 
Therefore: 

2 : 16 : : 40 : .v = 360 grams of water 
H O grams H,0 

Name two or more elements which ignite on contact with 
water. 

Potassium and sodium. 

HYDROGEN 

Give (a) the symbol of hydrogen and (b) state the form in 
which it exists in nature; (c) give a short description of its 
physical and chemical properties. 

(a) II. 

(b) As II in volcanic and natural gases; II 2 0, in which form it is pres- 
ent to the greatest extent in combination; in natural 11,: and a 
constituent of all animal and vegetable structures. 

(c) It is a colorless, odorless, tasteless gas; combustible, burning with 
a colorless flame, yielding the greatest heat of all combustible substances, 
not a supporter of combustion. The resulting compound of its combustion 
in air is water. It is only slightly soluble in water and is the Lightest of all 
elements. It is electropositive, capable of combining with many elements, 
as with O to form H 2 and I !.,()._,; with N to form NH,; with the halogen 
elements to form hydrogen acids. 

Name the (a) lightest of all known elements and (b) give its 
chemistry, (c) with a test to prove that it will not support 
combustion, and (d) name the combination in which it is 
most commonly found. 

(a) Hydrogen. 



46 PHYSICS AND CHEMISTRY 

(b) See (c) of question immediately preceding. 

(c) A burning taper is extinguished when plunged into a jar of hydrogen, 
the mouth of the jar being downward, although the hydrogen burns as it 
passes from the jar into the air. 

(d) Water. 

Give two methods of obtaining hydrogen and write the 
equations of the reactions pertaining thereto. 

i. Zinc treated with dilute sulfuric acid. 

Zn 2 + 2H 2 S0 4 + H 2 = 2ZnS0 4 + 2 H 2 + H 2 0. 

2. An electric current passed through water slightly acidulated with 
sulfuric acid. 

H 2 + H 2 S0 4 + electric current = ions of H 2 + S0 4 . 

The S0 4 ions split into S0 3 + ions, the S0 3 ions unite with H 2 to 
form H 2 S0 4 ,this H 2 S0 4 again passing through the same cycle. 

Describe the method of preparing H by the action of Na on 
H 2 0. Write the formula for the equation representing the 
reaction and find how many grams of H, 82 grams of Na would 
liberate by this process (atomic weight of Na, 23; H, 1 ; O, 16). 

Plunge small pieces of Na, which has been freed from naphtha and 
cleaned, well wrapped with fine wire gauze into an inverted glass jar filled 
with water. The water immediately undergoes decomposition with the 
production of H, which collects at the top of the jar, and NaOH, which is 
held in solution in the water. 

Na + H 2 = NaOH + H. 
23+18 = 40 +1 parts in grams. 

WATER 

Give the composition of water (a) by volume, (b) by weight, 
and (c) give its molecular weight. 

(a) Two volumes (22,320 cc.) of H with one volume (11,160 cc.) of O. 

(b) Two parts (as 2 gm.) of H with sixteen parts (as 16 gm.) of O. 

(c) 18. 

Determine the composition of water by (a) analysis, (b) 
synthesis. 

(a) When water, slightly acidulated with sulfuric acid, is placed in a 
special form of apparatus having two tubes, and a current of electricity is 
passed through the mixture, the water is decomposed into two volumes of 
H for every one volume of O which collects in the separate tubes. 

(b) Hydrogen passed over copper oxid in a hard glass tube heated to 
redness, combines with the oxygen of the copper oxid to form water, which 
may be collected in a suitable weighed vessel and weighed. The increase 
of weight of the vessel represents the weight of water produced and is the 
sum of the hydrogen employed and the weight of the oxygen given off by 
the copper oxid. 

How may water be decomposed? 

1. See preceding answer, (a). 



By panting i team I through an 

and pastes out at tin- distal end of tin- pipe, the 
n uniting with the iron and forming .1 coating oi u o the 

pipe. 

What is water chemlcaDj considered? 

It i> tin and la neutral in reaction. It m 

an dectropoaitive or basic substam e, a^ n hen it i ombinea a ith a4 idii i 
to form oxyadds, such a 50 H 8 H,S0 4 . It may act as an el 
negative or acidulous substance, as in its union with I ich aa 

K_( • • H,( I >K( >I1. 

What is meant by a (a) hard water, b a soft water, arul £ 
how ma\ a hard water be rendered soft? 

(a) Water holding in solution mineral salts other than alkali* 
decomposes soap, yielding an insoluble precipitate, and does not readily 

produce a lather. 

(b) Water holding in solution very little or no mineral salts, rea 
producing a lather with soap, with very little or no decomposition, 

(c) When the hardness is due to calcium bicarbonate or other bicar- 
bonates, boiling causes a splitting of the bicarbonates into insoluble car- 
bonate, water and carbon dioxid, which passes ol'f into the air, tl 
rendering the water soft 

By distillation or the addition of an alkali or lime-water, the latter in 
not too large a quantity, water may be rendered soft. 

Define hardness as applied to potable water and give its 
influence upon the physiologic processes. 

See preceding question, (a). 

Water containing more than a certain quantity of mineral salts when 
employed in the preparation of albumin-containing foods, as meat-. 
etc., renders the albumin less digestible by causing the formation of hard 
masses of albumin combined with the metals. 

When the hardness is due to bicarbonates, the latter neutralize 
the hydrochloric acid of the stomach, thereby interfering with the action of 
pepsin in gastric digestion. 

Hard water often produces intestinal derangement in persons not 
accustomed to its use, and is believed by some to favor the formation of 
urinary and other calculi. 

Illustrate by formula the decomposition of (a) water by 
potassium, (b) sulfuric acid bv iron. 

(a) 2H„0+K, =2KOH^H, 

(b) 2H 2 S0 4 + Fe 2 =FeS0 4 +2H 2 

How can it be determined that the composition of water is 
H 2 0? 

By analysis. Electrolysis of water gives us two volumes of hydrogen 
and one of oxygen. 

By synthetic action. Mixing two volumes of hydrogen, weighing 



48 PHYSICS AND CHEMISTRY 

2 grams and an equal volume of oxygen, which would weigh 16 grams, in 
a jar. By causing an electric spark in the jar 18 grams of water vapor 
would be formed. 

OXYGEN 

Describe oxygen as to (a) occurrence, (b) physical properties, 
(c) chemical properties, and (d) give two methods of obtaining 
it. 

(a) Oxygen is the most abundant element in nature, occurring free in 
the air, of which it forms about 1/5 part by volume. It is found widely 
distributed in chemical combination as water, of which it forms 8/9 part by 
weight, as oxids, oxyacids, oxysalts, and in almost all animal and vegetable 
compounds. 

(b) It is a colorless, odorless, and tasteless gas, the supporter of com- 
bustion, but noncombustible, soluble to the extent of about 3 per cent, in 
water at ordinary temperatures. It may be liquefied and solidified under 
certain conditions of temperature and pressure. 

(c) It is the most powerful electronegative (anionic) element, capable of 
uniting with all elements except fluorin, bromin, and the helium group. 

(d) 1. Barium monoxid, when heated in the air, takes up an atom of 
oxygen, forming barium dioxid, which, when heated in a vessel from which 
the air is excluded, yields one atom of oxygen for each molecule of barium 
dioxid. 

BaO + O = Ba0 2 . 
Ba0 2 heated = BaO + O. 
2. By heating potassium chlorate alone or mixed with manganese 
dioxid, to prevent too rapid decomposition and avoid explosion. 
KCIO3 in air (O) = KC10 4 . 
The KC10 4 under heat = KC1 + 4 . 
or 2KCIO3 heated = KCl + 30 2 . 

For what element is there the most extensive affinity? 

Oxygen. 

State one of the reasons for regarding the atomic weight of 
oxygen as 16 instead of 8. 

By comparing its density with hydrogen it is found to be 16. 

Explain the following terms: Slow combustion, combustible 
substances, supporter of combustion. 

Processes of oxidation evolving no light and but little heat are called 
slow combustion. 

A combustible substance is one which chemically combines with cer- 
tain other substance so violently as to evolve light and heat. 

A supporter of combustion is a substance in which combustion may 
take place; i.e., oxygen and sulphur gas. 

HYDROGEN DIOXID 

Describe hydrogen dioxid, and give a method of preparation 
with the equation pertaining thereto. 



1 1\ drogen dioxid (perozid), irfaen , 

Odor .similar tO tli.it Oi I Weak solution oi chlorij 

consisteno I loluble fa water, alcohol, and ether in all pro 
portions, ha found In commen nail) an aqu< 

taining j pei cent of hydrogen dioxid, ora iti< [( 

readily »li*t umposi's into water and »»w i»cn al ordinary temp more 

rapidly at higher temperatures. 

Pre^ora&y*.— Phosphoric add acting on barium <l> pended in 

irater. 

i; i( », H r<> ( li. < > BaHPO, • n I i H,0. 
The hydrogen diozid is beld in Bolution in tin- water, which is withdi 
from tlu- mixture and evaporated in a vacuum over sulphuric add to the 
desired consistency. 

Describe the chemical changes that occur In the process of 
bleaching* Name two bleaching agents used in dentistry. 

The prindple of most bleaching agents is the liberation <>i oxygen to 
combine with the chemical elements of the stain, changing its composition 
and consequently decolorizing it. 

Perozid of hydrogen and chlorinated lime. 

What chemical change occurs in the action of H.,0 2 as a 
germicide or antiseptic. 

It is decomposed when brought into contact with organic matter and 
nacent oxygen liberated. The oxygen combines with the organic matter, 
oxidizing it, destroying the bacteria and rendering the soil sterile. In 
putrescent pulp canals this effect combined with the mechanical action of 
the ebulition of the oxygen makes this agent particularly valuable. 

Give the formula of hydrogen dioxid and name its uses in 
medicine. 

H 2 Oo. Antiseptic, deodorant, and styptic; hence serviceable as a topic 
application to the throat in diphtheria and scarlatina or as a disinfectant 
lotion for wounds and abscesses. It may be administered internally 
antidote to cyanids, phosphorus, and alkaloids. It may be employed as 
a bleaching agent for the bleaching of teeth and hair. 

To what are the bleaching and antiseptic properties of hydro- 
gen dioxid due? 

To the production of nascent oxygen from the hydrogen dioxid. 

Give the atomic and molecular weight, the atomic and 
molecular volume, and the density of oxygen. 

Atomic weight, 16; molecular weight, 32; atomic volume, 1 (n.16 
liters); molecular volume, 2 (22.32 liters); density (specific gravity) 
compared with H, as i,= i6; density (specific gravity) compared with 
air, 1. 1056. 

Give a brief description of three experiments illustrating the 
properties of oxygen. 

4 



50 PHYSICS AND CHEMISTRY 

i: A piece of smouldering charcoal placed in a jar of oxygen bursts into 
flame, burning vividly. 

2. A small piece of dry phosphorus warmed in a deflagrating spoon 
and plunged into oxygen burns with a brilliancy painful to the eye. 

3. A steel watch-spring tipped at one end with burning sulfur, when 
placed in oxygen, burns with intense light and emits sparks. 

What element composes over half the matter of the earth 
and is the common supporter of combustion? 

Oxygen. 

OZONE 

Name and describe an allotropic form of oxygen, giving its 
symbol. 

Ozone, symbol 3 , a colorless gas having an odor resembling that of 
chlorin, irritating to mucous membranes and rapidly producing head- 
ache. It is a powerful oxidizing agent, rapidly destroying organic matter 
and oxidizing metals; it bleaches vegetable coloring matter. It is lique- 
fiable and forms an intensely blue liquid. 

Compare ozone with oxygen as to (a) occurrence, (b) 
properties. 

(a) Ozone is found in the air in extremely small quantities, especially 
in the atmosphere of cities; it is more abundant in the air of pine forests 
than elsewhere, due to the oxidation of the turpentine. Oxygen is present 
in all atmospheric air to the extent of 21 per cent, by volume. 

(b) Ozone is a most powerful oxidizing agent, attacking metals like 
mercury upon which ordinary oxygen fails to act, and supports combustion 
more vigorously than oxygen. Ozone will not support life. It acts on 
the respiratory mucous membranes as an irritant, whereas oxygen is the 
supporter of respiration. 

NITROGEN 

Give (a) the symbol, (b) atomic weight, (c) molecular 
weight, and (d) describe the properties of nitrogen (azote) . 

(a) N. (b) 14. (c) 28. 

(d) A colorless, odorless, tasteless gas, neither combustible nor a sup- 
porter of combustion, and slightly lighter than air. Nitrogen is chemically 
inert, having little affinity for other elements except magnesium and a few 
others. Its compounds are unstable, often decomposing with explosive 
violence, as nitroglycerin. It is not poisonous, but animals cannot live 
in the pure gas because of the absence of oxygen, which is required for 
respiration. 

Give (a) the occurrence of nitrogen and (b) state its im= 
portance in the free state, in combination (c) in inorganic, 
and (d) in organic compounds. 

(a) It occurs free and as ammonia in the air; as nitrates and ammo- 



\l IP 



$1 



nium salt> in the earth and in | u'nial 

compounds proteins). 

I iluent of the Inspired air !<> prevent tOO rapid I 

of the tissues and i> ne< the lite of i ertain lower orders of fill 

It forma very u i i ^ «- 1 ompounda, aa ammonia, nitrates, and «.-.. 

(d) It forma with C, 11. and highly e\|)l<»>i\<- compounds, sa gun- 
COttOn and nitroglyi erin ; extremely poisonoua i Ompounda, as hydnx yanic 

add and alkaloids; and substances of great nutritive \alu« ids. 

QfVe two methods of obtaining nitrogen and Mate BOH it 
ma\ he distinguished from hydrogen. 

i. Hum phosphorus in a hell jar inverted over water. Th< 
unites with the phosphorus to form PjOg, which unites with the 

to form HjPO^ leaving the nitrogen. 

j. Heat a mixture o\ ammonium chlorid and potassium nitrite in a 
lari;e volume o\ water. Equation: 

MI 4 n + KNOj - KCl-f 2II.0 + \ 

Describe the preparation of nitrous oxid (laughing-gas , 
writing the equation of the reaction occurring. State the 
properties and uses of nitrous oxid. 

By heating ammonium nitrate to 250 C. in a retort, water and nitrous 
oxid are produced. To purity the gas it is passed through a solution of 
ferrous sulfate to absorb any nitric oxid, and then through a solution of 
sodium hydroxid to remove any hydrochloric acid that may have been 
derived from the presence of ammonium chlorid. The gas should be 
collected over hot water, as it is soluble in cold water. Equation: 
NH<N0 3 heated = 2 H,0 + N 2 0. 

It is a colorless, odorless gas, having a sweetish taste; not combustible, 
but a supporter of combustion. It is used as an anestJictic in minor opera- 
tions, as in the extraction of teeth and the divulsion of the anal sphincter, 
and is regarded as the safest anesthetic. 

How does N 2 rank as a supporter of combustion and of 
respiration? 

Nitrous oxide (N 2 0) is a supporter of combustion to a limited extent 
in that it is decomposed by a heated combustible substance and oxygen 
liberated. It does not support respiration. 

NITRIC ACID 

Give the names and formulas of the nitrogen acids. 

Nitrous acid, HN0 2 . Nitric acid, HN0 3 . 

Describe the process for the preparation of nitric acid with 
equation; its properties, and chemical and medical uses. 

Heating a native nitrate, as sodium or potassium nitrate, in a re- 
tort with sulfuric acid. The nitric acid distils over and is collected in a 
receiver. 

2NaN0 3 ^H 2 S0 4 = Na 2 S0 4 ^2HNO,. 



2KNO3 +H 2 S0 4 =K 2 S0 4 + 2HNO 



52 PHYSICS AND CHEMISTRY 

What is aqua regia and its principal property? 

Aqua regia (nitro hydrochloric acid): Obtained by mixing 40 c.c. of 
nitric acid with 180 c.c. of hydrochloric acid. The two acids act chemic- 
ally upon each other, forming chloronitrous or chloronitric gas, chlorine 
and water. It dissolves platinum and gold. 

AMMONIA 

What is ammonia? Give the sources and uses of ammonia 
in medicine and in the arts. 

Ammonia (NH 3 ) is a colorless gas having a characteristic pungent, 
suffocating odor, with strong alkaline properties. It is a volatile alkali. 
It is obtained chiefly from the ammoniacal liquors formed in the process of 
manufacturing illuminating gas. It may be obtained from its salts and 
certain nitrogenous organic compounds when heated with an alkali. 
It is used in medicine as a rapidly acting cardiac and general stimulant 
In the arts it is used as a volatile base, antacid, and as a general cleans- 
ing agent in the household in the form of the water of ammonia (hartshorn) . 

Give the composition and method of preparation of aqua 
ammonise. 

Aqua ammonia (ammonium hydroxid, hartshorn) is composed of one 
molecule of ammonia, NH 3 , in chemical union with one molecule of water. 

NH 3 + H 2 = NH 4 OH. The NH 3 is supposed to unite with one of 
the H atoms of water to form the radical NH 4 , which combines with the 
OH, hydroxyl group. It is prepared by heating ammonium chlorid with 
an alkali, as KOH, NaOH, or Ca(OH) 2 calcium hydroxid, the NH 3 gas 
being conducted into water kept at the temperature of the air. 

AIR 

Name the constituents of the atmosphere. Give the com= 
position of air by weight and by volume. 

Weight. Volume. 

Nitrogen 76 per cent. 77 per cent., about. 

Oxygen 23 per cent. 21 per cent. 

Water vapor Variable. 

Carbon dioxid 0.03 per cent. 

Argon 

Helium 

Neon 

Xenon 

Krypton 

Ammonia 

Ozone 

Nitric acid 

Sulfurous oxid 

Hydrogen sulfid (in towns), 



Helium group °-937 P e r cent. 



traces. 



What element constitutes four=fifths of the air? 

Nitrogen. 



53 

wii.it percentage of CO exists nonnaJlj In the atmoaphere? 
What percentage <>i" CO Is dangerous t<> lift ? 

o.o^ pei t int. by volume. 

Air containing o. 1 pel Cent of COj derived from the irnj»nriti- 

animal respiration is vitiated and dai From 10 t<> i 

cent i errved from source* other than animal respiration n 

the air poisonous, but not immediately fatal. 

Describe ■ method by which the four chief constituents of 
atmospheric air maj be determined. 

\ graduated glass tube containing a measured volume i 

placed with the open end downward into a dish containing mercuri \ 
small piece of phosphorus i> allowed to remain in contact with thr air 
for several hours, when it gradually absorbs or combines with tl 
The remaining volume of air i- chiefly nitrogen while the loss in v. 
represents the oxygen. For the determination of carbon dioxide and 

water vapor, a measured volume of air i^ passed through two l'->haped 

glass rubes. ( me oi these has previously been filled with pi< Icium 

chlorid, the other with pieces of potassium hydroxid, and both bavi 

weighed separately. The first tube will retain the water vapor and the 
second the carbon dioxid. The increase in weight of the tubes at the 

end of the operation will give the amounts of the two constituents. 

How is the air of an apartment tested to determine the 
presence and amount of carbon dioxid in it? 

By exposing a measured volume of the air to a definite volume of lime- 
water of a previously determined alkaline strength, by means of a dec i- 
normal oxalic acid solution. When all the carbon dioxid has combined 
with the lime-water, the alkalinity of the solution is again determined by 
means of the oxalic acid solution. The difference between the alkalinity 
before and after the addition of the air indicates the quantity of lime-water 
necessary to remove the carbon dioxid present in the volume of air acted 
upon, from which the amount of carbon dioxid is calculated. 

CARBON 

Give (a) the symbol, (b) specific gravity, and (c) the physical 
and chemical properties of carbon. 

(a) C. (b) 3.5, compared with water, when in the form of the dia- 
mond, and 2.25 as graphite. 

(c) Carbon is a solid, always black except in the form of the diamond, 
devoid of taste and odor, insoluble in all known liquids, and combustible, 
yielding C0 2 . It is the transitional element which unites the three natural 
kingdoms. It enters into combination with many elements, producing 
very important compounds, as CN, HCN, C< K CH 4 . 

Describe the various allotropic forms of carbon. 

Diamond, graphite, charcoal (coal, coke, animal and vegetable charcoal 
lamp-black). 

Diamond is the purest form of carbon; crystalline (either in cubes or 
octahedra), the hardest substance known, and possessing the gn 



54 



PHYSICS AND CHEMISTRY 



refractive power. It is a nonconductor of electricity and a poor conductor 
of heat. It burns at a high temperature, forming carbon dioxid. 

Explain the structure and luminosity of a candle flame. 

It consists of three cones. The inner or central cone is chiefly un- 
burnt gas; the second is formed of partially burnt and burning gas; the 
outer cone showing the highest temperature, but scarcely any light is that 
part of the flame where complete combustion takes place. The light of 
the flame is caused by solid particles of carbon heated to a white heat. 
The separation of carbon in the flame is explained by the fact that hydro- 
gen has a greater affinity for oxygen than has carbon; only a limited 
amount of oxygen can penetrate into the flame and the hydrogen of the 
hydrocarbon will consume this oxygen, the carbon being liberated momen- 
tarily until it reaches the outer cone, where it finds sufficient oxygen with 
which to combine. 

This flame is the same as illuminating gas in principle, but when a 
sufficient amount of air is previously mixed with illuminating gas, no 
separation of carbon takes place, and therefore no light is produced but 
a more intense heat is generated. This is illustrated in the Bunsen burner 
where holes are drilled in the burner tube below the flame. 

What are the products of the combustion of ordinary coal? 

Carbon monoxid and dioxid, with some sulfurous oxid and hydrogen 
sulfid. 

What is the principal atom having linking functions? 

Carbon. 

CARBON MONOXID AND CARBON DIOXID 

Give the name, formula, and properties of the two oxids of 
carbon, explaining the effect of each on animal life. 

Carbon monoxid, CO, a colorless, odorless and tasteless gas; lighter 
than air and burning with a blue flame, forming carbon dioxid. It acts as 
a direct poison to animals, entering into combination with the hemoglobin 
of the blood by displacing the oxygen to form carbon monoxid hemo- 
globin, which is a more stable compound than oxyhemoglobin, thereby 
depriving the hemoglobin of its oxygen- carrying power. 

Carbon dioxid, C0 2 , is a colorless gas having a slightly acid taste. It 
is heavier than air, soluble in water, upon which it confers increased sol- 
vent power. It is neither combustible nor a supporter of combustion. Pure 
carbon dioxid causes instant suffocation by "spasm of the glottis." 

Mention three great natural sources of C0 2 . 

Animal respiration, burning of carbonaceous substances, and certain 
processes of fermentation. 

What effect does carbon dioxid produce on lime=water? 

It produces a white precipitate of calcium carbonate, which is dis- 
solved by an excess of carbon dioxid, owing to the formation of calcium 
bicarbonate. 



55 

METIHAM: AM) 1. 1 HAM 

What is medUUlC marsh ^«'i s '■ (Hvt its formula and 
chemical importance with a method ot pr\ -paration. 

Methane, also known by the nam. ."./-, i | oolorictt, «>' iorless 

gaa, bighly inflammable, produi log t onaiderable beat but little 01 no light. 

it may be looked upon aa the ttarting-point In the product! 

ink compounds Formula, ( "li 4 . 

Pre paration: Heating ■ mixture ot sodium gu etate and sodium hydi 
with ozid oi calcium (lime). 

N.u II ,« >. • Vk »H \. . ' I I I II,. 

What is olefiant gas? Give some of its properties. 
(ethene, ethylene), <\.H,, ia a colorless gaa, I 
ethereal odor; combustible, and producing a bighly luminous flame. 

DISINFECTANTS AND ANTISEPTICS 

What distinction do you make between a disinfectant germi- 
cide and a deodorant? Give examples of each. 

A disinfectant is an agent which destroys disease germs and the noxious 
properties of fermentation and putrefaction. Examples: chlorinated lime, 
formaldehyd, mercuric chloric!. 

A deodorant is a substance which removes or corrects offensive odors, 
but may not destroy disease germs. Examples: zinc chlorid, carbolic acid. 

Mention some substances used for disinfection after the 
prevalence of contagious disease and explain their action. 

Sulfur when burned yields S0 2 , which destroys germs by its dehy- 
drating action. Xot very valuable. 

Chlorinated lime in solution, when in direct contact with the articles 
to be disinfected, or acted upon by an acid, yields chlorin gas, which in the 
presence of moisture unites with the hydrogen, setting free oxygen; the 
oxygen then destroys disease germs. 

Formaldehyd (formalin, 40 per cent, solution of formaldehyd in water) 
is one of the best disinfectants, acting in its gaseous form. 

How do antiseptics differ from disinfectants (germicides)? 
Give some examples. 

An antiseptic is any substance that inhibits the growth of micro-organ- 
isms, destroys or renders innocuous the poisonous products of their acti< m 
upon the tissues of the body, or retards or prevents the absorption of such 
products. Examples: carbolic acid, creolin, boric acid, potassium per- 
manganate. 

Disinfectants possess antiseptic attributes, but do not destroy the micro- 
organisms. 

Describe the occurrence of sulfur in nature. 

Sulfur is formed in the uncombined state, mixed with earthy matter, 
in volcanic districts, chiefly in Sicily. In combination, it is widely 
diffused in the form of sulfate (gypsum CaS0 4 , 2H.O), sultids (iron 



56 PHYSICS AND CHEMISTRY 

pyrites, FeS 2 , galena, PbS, cinnabar, HgS, etc.). It is found in many 
organic compounds and mineral waters. 

Mention with regard to sulfur, (a) atomic weight, (b) 
valency, (c) color, (d) odor, (e) taste, (f) solubility, (g) behavior 
when heated. 

(a) 32 (31.97); (b) 2.4.6; (c) yellow; (d) no odor; (e) no taste; (f) 
soluble in water and nearly so in alcohol, soluble in benzene, ether, 
chloroform, carbon disulfid, oil of turpentine, and fat oils; (g) melts at 
23 9 F. to an amber colored liquid, increasing the heat it becomes brown 
and thick and at about 392 F. it is tenacious and scarcely flows, when 
still further it becomes thin and liquid, and finally boils at about 824 F. 

Give the formula and properties of sulfurous acid. 

Sulfurous acid, formula H 2 S0 3 , is a colorless acid liquid. It has the 
odor of sulfur dioxid, is unstable, when exposed to air absorbs oxygen 
and becomes sulfuric acid, H 2 S0 4 . 

What is blue vitriol? Describe the manufacture of blue vitriol 
and state its properties. Mention its uses in dentistry. 

Blue vitriol, cupric sulfate, CuS0 4 , 5H 2 0, is made by dissolving 
cupric oxid in sulfuric acid. The sulfate forms in large transparent, 
deep blue crystals, soluble in water and of a nauseous, metallic taste. Dis- 
solved in ammonia, it is used as a styptic and astringent and in solutions 
of galvanic cells. 

When sulfur is burned in the air, what is the product and 
what are its uses? 

Sulfur dioxid, S0 2 , is the product. It is used as a bleaching and dis- 
infecting agent, and to prevent or limit fermentation; as a germicide in 
skin diseases. In the arts it is employed for the preparation of sulfuric 
acid, in metallurgy, and as a vulcanizing material. 

Describe the manufacture of H 2 S0 4 . 

Sulfuric acid is manufactured on a large scale by passing a stream 
of sulfur vapor, nitric acid vapor and steam into large leaden tanks, 
sulfuric acid condenses on the floor and is drawn off, concentrated and 
purified. 

What is CaS0 4 and what are its uses in dentistry? 

CaS0 4 is calcium sulfate or plaster of Paris (dried gypsum). It 
is used for taking impressions, making models, and investing plates for 
vulcanizing, etc. 

Give the properties, impurities, and uses of sulfuric acid. 
Give methods for detecting the impurities. 

When pure it is a colorless, odorless, heavy, oily liquid, having a 
specific gravity of 1.84. It chars organic matter, which yields a brown to 
black color to the acid; hence the light brown color of the commercial 
variety. 

Impurities: The most important are lead from leaden chamber and 



PHO : 57 

pan-, and rom the u « ai< whi< i> i i pre enl In naturally <•< i airing 

iron sultul. Lead may It detected b) largel) diluting the add with 
water, when ■ white precipitate of lead Miuatc may 

be detected b] Reinscn'ioi Marsh's test 

It is more extensively employed in the industries than any other chemfc 
compound: In the manufai lure of glucose, the various sulfates of tn< 
loids and inorganic salts. In medicine it is used as an escharotu in the 
form of pastes and internally in the form of aromaHt sulfm 

What is hydrogen sulfid (sulfuretted hydrogen ? Shovi 
h\ aquation hovi it is obtained in the action of hydrochloric 
acid on calcium sulfid. 

\ colorless gas having the odor of rotten eggs, soluble in water, 
combustible under certain conditions. When inhaled pure it i 
toxic 

( aS + »HC1 - CaCl, H H,S. 

Give the formula of hydrogen sulfid and its properties and 
USeS. HOW may it be detected in solution? 

H,S. 

Properties (see also preceding question). — It is used as a 
for the precipitation of metals as sulfids, especially those of the * 
group. In medicine it IS used as naturally occurring sulfur water in the 
treatment of skin diseases and was formerly employed internally fol 
sumption. 

It may be detected by its odor and by bringing paper moistened with 
lead acetate in contact with it, when black sulfid of lead is formed 

How is hydrogen sulfid formed in nature and how is it 
ordinarily prepared in the laboratory? 

It results from the decomposition of organic matter containing sulfur 
in the presence of moisture; from putrefaction of proteids in the intestines, 
and in foul abscesses. 

In the laboratory it is prepared by the action of dilute sulfuric aeid 
upon ironsultid, as shown by the equation: FeS + H 2 S0 4 = FeS0 4 +H 2 S. 

PHOSPHORUS 

Give (a) the symbol, (b) valence, (c) atomic weight, (d) 
molecular weight, (e) names of the allotropic forms of phos= 
phorus, with their physiologic action. 

(a) P; (b) 1.3.5; ( c ) 3 X > (d) I2 4l ( e ) yellow, red, white, and black. 
They are all poisonous except the red variety. 

Give the occurrence in nature, and the properties of phos= 
phorus. 

In nature it is never found free, but as phosphates, as in sombrerite 
and apatite (calcium phosphates). Phosphates are essential to the growth 
of plants. Phosphorus is a constituent of protoplasm and is present in 
combination as phosphates in the urine and bone. 

It is a translucent, yellowish, wax-like, solid stick, with a garlicky odor; 



58 PHYSICS AND CHEMISTRY 

sparingly soluble in water, but freely so in carbon disulfid, ether, and cer- 
tain oils. It is spontaneously inflammable in air, especially in a finely 
divided state, and is highly toxic. It emits light in the dark. Chemically 
it is an electronegative (anionic) element, readily combining with oxygen 
to form oxids, and with chlorin and other elements. 

What is the usual source of phosphorus in commerce? 

Bone-ash, Ca 3 (P0 4 ) 2 , after being treated with sulfuric acid, is evapo- 
rated to a syrupy consistence and then distilled with charcoal and sand, 
the phosphorus being collected in molds under water. 

Give formula, method of preparing phosphoric acid, and its 
properties. 

It may be prepared by warming bone-ash with sulfuric acid, or by 
treating phosphorus with nitric acid and water in a retort under carefully 
guarded heat, until all the phosphorus has disappeared. The solution is 
evaporated until all the nitric acid is expelled. It is a colorless, syrupy 
liquid, without odor, having a strongly acid taste. It unites with bases 
to form phosphates. Formula: H 3 P0 4 . 

Differentiate glacial phosphoric acid and common phos- 
phoric acid, and state in what respect the action of the former 
on the animal system differs from the latter. 

Glacial phosphoric acid, H P0 3 , is solid, usually being marketed in the 
form of sticks. It is poisonous, coagulates albumen. 

Ortho-phosphoric acid, H 3 P0 4 (common phosphoric acid) is liquid, 
85 per cent, in strength, does not coagulate albumen. It differs from the 
glacial in that it forms a precipitate with magnesium sulphate, ammo- 
nium hydrate and ammonium chlorid. 

HALOGENS 

(Fl, CI, Br, I) 

Name and give the symbols of the substances called halogens. 
Why are they so called? 

Fluorin, Fl; Chlorin, CI; Bromin, Br; Iodin, I. Cyanogen, CN, may 
be considered one of this group. 

They are called halogens, " sea-salt producers," because of the close 
resemblance between their sodium salts and sea salt. 

In what respects do the halogen elements exhibit marked 
similarity, and how do they differ physically? 

They are all monad anionic elements, capable of forming hydrogen 
acids and the halogen salts, called fluorids, chlorids, bromids, and iodids. 
They all possess more or less bleaching and disinfecting properties, may 
exist in the gaseous state, and are toxic. Physically they differ in that 
fluorin is a colorless gas; chlorin, a greenish -yellow gas; bromin, a reddish- 
brown liquid, very volatile, yielding reddish-brown fumes; and iodin, a 
bluish-black, frabile solid (rhombic plates), having a metallic luster and 
forming violet vapor when heated. They differ in their degree of solu- 



II \l .»,. 

bflity, bleat bing, disinfectii I 

chlorio form oxidsj bromin and Qourin do not 

(ii\c the properties of chlorin. State the sources and 
mention the most important of its compounds used in medicine. 
lorin is a greenish-yellow .' Irritating to the milCOUl D 

branes, suffocating ami poisonous; soluble in v. teaching 

disinfecting agent 

With bydrogen it forms hydrochloric add, ami with metal>, 

called chlorids, being an electronegative, monad element 

• Prom sodium chlorid ami other chlorids in nature. It 
ho obtained by beating hydrochloric arid and manganese dioxid. u 
aHCl+MnO, MnCL+aH.0 + C1,; or heating sodium chlorid, 
manganese dioxid with sulfuric arid, as iNaCl • Mn<> • ll 
S0 4 • Mnt'L • iH,0 • CL; or beating chlorinated lime (chorid of lime 
(commonly), chlorohvpochlorile of calcium) alone or with an acid, .. 

Caaoa+H 1 S0 4 -CaS0 4 +H,0+Cl J . 

Compounds used in medicine: Sodium chlorid, mercurous chlorid, mer- 
curic chlorid, ferric chlorid, arsenious chlorid, zinc chlorid, cocain chlorid 
(Jiydrochlorid, muriate). 

How is chlorin prepared and how is it administered me- 
dicinally by the mouth? 

Preparation. — See preceding question, under Source. 
Administration. — In the form of chlorin water (liquor chlori com- 
positus), and in the form of salts, as chlorids. 

(a) In what compound is chlorin found most abundantly 
in nature? (b) Upon what do the bleaching and disinfecting 
properties of chlorin depend? 

(a) Sodium chlorid, XaCl. 

(b) Upon the intense affinity of chlorin for hydrogen in water, with 
which it unites to form hydrochloric acid, liberating the oxygen, which 
in its nascent state is the really active agent in destroying color>. odors, 
germs, and their products. Chlorin acts as a bleaching or disinfecting 
agent only in the presence of moisture. 

What is the exact difference between chlorin ions and 
chlorin gas? 

Chlorin, reduced to its smallest proportion as a gas, would he one 
molecule or two atoms. Chlorin ions are formed when the gas is acterf 
upon by electrolysis, the molecules being split up and the ions, being 
negative, collect at the positive electrode. After being discharged the 
ions cease to be ions, and appear as elements in the free state or as some 
definite compound. 

How is chlorinated lime made and what are its principal 
uses? 

By passing chlorin gas over slaked lime spread in thin layers upon 
shelves in a speciallv constructed room. 

Ca(OH),+ Cl 2 = CaClOCl- H 2 0. 



60 PHYSICS AND CHEMISTRY 

It is used chiefly as a bleaching and disinfecting agent. When exposed 
to the air or brought in contact with an acid it yields chlorin, which acts 
in the manner described in the preceding question. 

What acid contains chlorin as an important element? 

Hydrochloric acid (muriatic acid), HC1. 

Describe hydrochloric acid as to (a) occurrence, (b) prepara= 
tion, (c) physical, and (d) chemical properities. 

(a) It occurs in volcanic gases, in the air over chemical works where it 
is being manufactured, and in the gastric juice of animals. 

(b) By heating sodium chlorid with sulphuric acid, as — 

2 NaCl + H 2 S0 4 = Na 2 S0 4 +2HCl, 
the gas being collected in water and by appropriate means brought to 
a definite strength, in which form it appears in commerce as "muriatic 
acid." 

(c) It is colorless, posionous gas, very irritating to the respiratory 
passages, and with a strong acid taste. It is very soluble in water, form- 
ing the liquid oridnary called hydrochloric acid. 

(d) It is a hydrogen acid forming with metals or basic substances 
salts called chlorids. 

Name the principal sources (occurrence in nature) of bromin 
and give its uses in medicine. 

Bromin is present in natural mineral waters and the sea, in the form of 
bromids, from which it may be obtained as stated in next question. 

It is used for the preparation of bromids, as sodium, potassium, ammo- 
nium, gold, arsenic, iron bromids, which are used in medicine. It is 
employed in the preparation of sodium hypobromite required in urinalysis 
for the determination of urea. It is rarely employed as a caustic in the 
treatment of gangrene and large sloughs. 

Describe the properties of bromin and give a method for 
its preparation. 

Properties: See page 58, last question. 

Preparation: It is chiefly prepared from the "mother liquor" of salt 
wells, which contains magnesium and sodium bromids, by evaporating it to 
dryness, mixing the residue with manganese dioxid and sulfuric acid 
and distilling. 

Equation: MgBr 2 + Mn0 2 + 2H 2 S0 4 = 

MgS0 4 +MnS0 4 +2H 2 + Br 2 . 

State the source of bromin and the group of elements to 
which it belongs. Describe a method of preparing bromin. 

Sea water or mineral springs containing magnesium bromid. It is 
a member of the halogen group. It is prepared by passing chlorine gas 
through a strong solution of a bromid, bromin vapor passing over into a 
condenser forming liquid bromin. 

To what chemical group does iodin belong? How is it 
obtained? What use is made of it in dentistry? 



1 1 \i» 

Iodin bdOHgl tO the '/.roup 1 1 t I ; by 

iraahing the ashes mble 

constituents. Sodium chlorid and sodium .iml potassium laibonan-* are 
removed b) evaporation ami crystallization, and the remaining mother 
liquor lodin i-> obtained by treating with n I and hy- 

drochloric add. The liberated iodin distills an. I is collected in o 
receh 

It i^ used in dentistry as a counter irritant and as an antiseptic in root 
canals, As ^n astringent ami in tin- form of Iodoform as and 
dressing. 

SILVER 
(Ag) 

Describe the element silver and give the names of ttfl most 
important compounds and their uses in medicine. 

Silver is a pun- white, brilliant metal ; specific gravity, 10.5. It is mall- 
eable, ductile, a m><>.i conductor of heat and electricity. It does not oxidize 
in the air, but readily tarnishes in air containing traces of hydrogen sufid. 

( \>>npon?hIs: Silver nitrate, used in solution locally as a COUSitC and as 
lunar caustic, which IS \ \ ( > ; fused with IK'l and molded into sticks, 
and as a stimulant; internally in pill form as an astringent and alt< rat he. 

Argyrol, protargol, and other new compounds of silver with organic 
substances are used as substitutes for silver nitrate, as germicides, astrin- 
gents, etc. 

Pure silver ici re is used in surgery. 

What salt of silver is commonly used in medicine? Give 
its formula, preparation, and properties. 

Silver nitrate was the most commonly used, but is being superseded by 
the new organic compounds above mentioned. Formula: AgX0 3 . 

Preparation: Pure silver is dissolved with pure nitric acid and water 
in a tlask under the action of heat. The solution is evaporated and the 
silver nitrate allowed to crystallize out. It is further purified by recrvs- 
tallization. 

It is a colorless, odorless, transparent, tabular, rhombic, crystalline 
solid, with a bitter, caustic, metallic taste, neutral reaction, becoming 
gray or black on exposure to light in the presence of organic matter. 
See preceding question (b), for its other properties. 

Give a test for silver in the form of silver nitrate in solution. 

Hydrochloric acid or a soluble chlorid yields a white precipitate of 
silver chlorid, AgCl, insoluble in nitric acid, soluble in ammonium hy- 
droxid from which solution it is reprecipitated by neturalization with ni- 
tric acid. 

LEAD 

(Pb) 

Give (a) the symbol, (b) atomic weight, (c) valence, and 
(d) physical properties of lead. 

(a) Pb; (b) 206.9; ( c ) diad and tetrad. 



62 PHYSICS AND CHEMISTRY 

(d) Lead is a soft, bluish-white ductile, malleable metal, which 
when freshly cut exhibits a bright metallic luster. On exposure to air the 
bright surface becomes quickly covered with a film of oxid. Specific 
gravity, 11.4. 

Give (a) the chemical and (b) pharmaceutical name and 
(c) the formula of sugar of lead, and of litharge. 

Sugar of lead: (a) Plumbic acetate; (b) plumbi acetate; (c)Pb(C 2 H 3 2 ) 2 - 
+ 3 H 2 0. 

Litharge: (a) Lead oxid; (b) plumbi oxidum; (c) PbO. 

Give some tests for lead in solution in the form of a salt. 

1. Hydrochloric acid yields a white precipitate of lead chlorid, PbCl 2 , 
soluble in hot water, from which it crystallizes on cooling. 

2. Potassium chromate yields a yellow precipitate of lead chromate 
(chrome yellow), PbCr0 4 . 

3. Sulfuric acid produces a white precipitate of lead sulfate, PbS0 4 . 

4. Potassium iodid produces a yellow precipitate of lead iodid, Pbl 2 , 
soluble in hot water, from which it crystallizes in shining, yellow leaflets. 

Give a chemical antidote for sugar of lead. 

Magnesium sulfate or any soluble sulfate. 



MERCURY 

(Hg) 

What metal is liquid at ordinary temperature? 

Mercury, hydrargyrum (quicksilver). 

How does mercury occur in nature? Give its physical and 
chemical properties, and name and give the formulas of some of 
its compounds used in medicine. 

It is found free and in combination as a sulfid, HgS (cinnabar), in Cali- 
fornia, Spain, Mexico, and other countries. 

Mercury is a bright, silver- white, liquid metal; specific gravity 13.59. 
It does not tarnish on exposure to air, but when heated is slowly converted 
into the red oxid. 

It is an electropositive element, capable of uniting with anionic elements 
and forming a large number of compounds, which are of two varieties — 
mercunws and mercuric. 

Compounds used in medicine: Mercurous chlorid (calomel), HgCl; 
mercuric chlorid (mercury bichlorid, corrosive sublimate), HgCl 2 ; mer- 
curous iodid, Hgl ; mercuric iodid, Hgl 2 ; mercurous oxid, Hg 2 0; mercuric 
oxid, HgO; mercuric nitrate, Hg(N0 3 ) 2 . 

Give the properties of (a) calomel, (b) corrosive sublimate, 
and give (c) two tests which will distinguish one from the 
other. 

(a) Calomel is a white, odorless, tasteless, impalpable powder, perma- 



nt-tu in the air, Insoluble In w.uci. it (a .t cholagog and 

iliur> 

is a lir.i\ y, < olorld I, Odoi olid, 

having an tcrid metallic taste, permanent In air, and soluble In 

It || .111 .:. philitii , </////v/>//< , and ■ \ it »l«n t COT1 

Calomel treated with ammonium hydrcudd producei ■ black 
of mercuroafl aninionium i blond. 

Corrosive sublimate with ammonium bydroxid jrieldi tL white precipi- 
tate of mercuric .unmonium chlorid. Calomel la ituolubU In water, cor- 
rosive sublimate is soluble. 

What mineral acids are incompatible with mercurous chloric!? 
(ii\e the formula and synonym of mercurous chlorid. 

Nitric, hydrochloric, and nitrohydrochloric acids, as they change it 
from an insoluble, nonpoisonous compound t<> the mercuric condition, in 

which form it is BOluble in water and highly toxic. 

Formula, e!< .: See page 62, under compounds used in medicine. 

Give the properties of potassium and give the names and 
formulas of some of its most important compounds used in 
medicine. 

Potassium is a soft, wax-like metal, having a silver- white luster when 
freshly cut, and rapidly oxidizing in the air. It decomposes water vio- 
lently, yielding XOH-f H. It is one of the most powerful alkalies. 

Compounds: Potassium iodid, KI; potassium cyanid, K( X ; potassium 
bromid, KBr; potassium chlorate, KC10 3 ; potassium carbonate, K,C< I ; 
potassium nitrate, KX0 3 ; potassium permanganate, KMn0 4 ; potassium 
bitartrate, KHC 4 H 4 6 . 

Give a method for the preparation, properties, and uses of 
potassium cyanid. 

Potassium cyanid is prepared by saturating a solution of caustic potash 
with hydrocyanic acid. It is a white, opaque, amorphous solid ; or a white 
granular powder, odorless when perfectly dry; deliquescent in the air and 
exhaling the odor of hydrocyanic acid. It is very poisonous. 

Uses: As a sedative for cough and in cardiac disturbances. 

Give the properties and uses of potassium permanganate. 

Potassium permanganate is a crystalline solid, forming slender mono- 
clinic prisms, and having a dark, reddish-purple color. It is odorless, and 
the taste is at first sweet, afterward disagreeable and astringent. It is 
soluble in water, forming a purple solution neutral to litmus. 

Uses: As a disinfectant, because of its oxidizing properties and as an 
antidote to morphin. 

SODIUM 

(Na) 

(a) Where does sodium occur in nature? (b) Give the 
names and formulas of three sodium salts used in medicine. 

Sodium is chiefly found in its most common salt, sodium chlorid, which 



64 PHYSICS AND CHEMISTRY 

is present in sea-water, natural spring waters, and in the fluids of animals. 

It is also found as other compounds, but never in the free state in nature. 

(b) Sodium chlorid, NaCl; sodium iodid, Nal; sodium bromid, NaBr. 

What is common salt? (a) How is it obtained? (b) Give 
the manner in which it acts when used in freezing mixtures. 

Sodium chlorid, NaCl. 

(a) By crystallization from natural waters containing it, or from solu- 
tions obtained by forcing water through salt-bearing rock formation, or by 
mining it. 

(b) When salt is mixed with snow or ice, the affinity of the salt for 
water causes a liquefaction of the snow or ice. To produce this change heat 
is required. This heat is obtained from substances in contact with the 
mixture. When the substances are liquid or gaseous, the amount of heat 
abstracted may be sufficient to cause liquids to become solid, and gases to 
become liquid or solid. 

What is sodium silicate? Mention its use in dentistry. 

Sodium silicate (Na 2 Si0 3 ) is formed by heating equal parts of sodium 
carbonate and sand and dissolving the mass in boiling water, forming a 
solution of sodium silicate or soluble glass as it is known. 

Bandages are soaked in this solution and applied to a fractured part. 
When dry they act as a cast or splint. 

Describe the simplest test for sodium and potassium salts in 
solution. 

The flame test. Platinum wire dipped in solution and held in the 
Bunsen flame will give a yellow color if sodium be present and violet if 
potassium. If both metals are in solution the two flames may be observed 
simultaneously by holding a piece of blue glass between the eye and the 
flame. 

Name three important calcium compounds. Give the 
formula and mention an important use of each compound 
named. 

Calcium sulfate (CaS0 4 +2H 2 0) when dehydrated forms plaster of 
Paris, useful in forming models, impressions, etc. 

Calcium carbonate (CaCO s ), marble, limestone, chalk. Precipitated 
calcium carbonate is used as a base for all tooth powders. 

Calcium hydrate (CaOH 2 ). Slacked lime used in the formation of 
plaster in the building trades. 

Give the chemical name and properties of (a) cream of 
tartar, (b) plaster of Paris. 

(a) Potassium bitartrate (see page 63, second question). 

(b) Calcium sulfate (CaS0 4 + 2H 2 0), which is partially deprived of 
its water of hydration by heat, converting it into the hydrate (CaSOJ 2 H 2 0. 
It is a fine white powder, odorless and tasteless, which with water forms 
a smooth, cohesive, rapidly hardening paste. 

How does plaster of Paris differ chemically from quick lime? 



Quick lime fa calcium oxid, CaO (burned linn 

im.i * ili ium sulphate, ( i ( ', I drl 

Describe the preparation end explain the setting <>f plaster <>i 

Paris. 

Gypsum b roasted at i temperature of about 14 i F. till about I 
thirds of it- prater of constitution i- driven off, and ■ nearly anhyd 
sulfate of calcium formed. Adding to plaster n 

the wrater oi constitution and forms ■ im.i— harder than the 1 
substance. 

Name tWO magnesium compounds, Give the formula an. .1 
mention an Important use of each compound named. 

Magnesium oxid (MgO) when brought in contact with prater 
magnesium hydroxid (MgOH,). Milk of magnesia i-> the bydrozid 
suspended in prater used to o\ ercome acidity of the mouth or Btomach and 
intestines and as a mild laxative. 

Magnesium sulfate, MgS0 4 , 7H,0 (Epsom salt) used as a laxal 

Name two important ammonia compounds used in dental 
practice and give specific uses of each. 

Ammonium chlorid, NH 4 CJ (Sal ammoniac) used in certain el< 
cells. 

Ammonia, NH r When this gas is dissolved in water we have the 
ordinary spirit of hartshorn or water of ammonia, used to neutralize acids 
and as the aromatic spirits as a heart stimulant and stomachic sedative. 

State the principal chemical compound formed when H 2 SO, 
is used in opening a root canal. Describe the process of neu- 
tralizing the excess of acid. 

Calcium sulfate. The excess of acid may he neutralized by working 
sodium bicarbonate or strong ammonia into the canal with a smooth 
broach. 

ARSENIC 
(As) 

Give (a) the chemical properties and (b) name some com- 
pounds with formulas of arsenic. 

(a) Arsenic is a steel-black nantneial with a metallic appearance, lying 
on the border-line of metals and nonmetals; very brittle, unoxidixed in 
dry air, but when heated in oxygen, burning with a bluish-white flame and 
producing arsenious oxid. It is electronegative in character; combines with 
hydrogen and metals to form arsenids, and with oxygen to form oxids. 
Its soluble salts are very toxic. 

(b) Arsenious oxid (trioxid, anhydrid, white arsenic) As,0 3 ; arsenic 
oxid (pentoxid), As._,() r> ; arsenious iodid (arseni iodidum), Asl,; sodium 
arsenate (sodii arsenas), Na a HAs0 4 +7H,0; Fowler's solution, which 
contains potassium arsenite. 

What compound of iron is used as an antidote for arsenic, 
(a) Write the equation showing the reaction of the antidote. 

5 



66 PHYSICS AND CHEMISTRY 

(b) How may the antidote be rapidly prepared? 

Ferric oxyhydroxid, hydrated oxid of iron (ferri hydroxidum cum 
magnesii oxido). 

(a) 4 Fe(OH) 3 + As 2 3 = Fe 3 (AS0 4 ) 2 + Fe(OH) 2 + 5H 2 0, or 

Fe(OH) 3 + 2 H 3 As0 3 « Fe 3 (As0 4 ) 2 + FeO + oH 2 0. 

The ferrous arseniate, Fe 3 (As0 4 ) 2 , is insoluble, therefore nonpoisonous. 

(b) By mixing a dilute solution of ferric sulfate or ferric chlorid with 
magnesium oxid and water, and thoroughly shaking. The entire mass is 
given at once. 

How would you proceed to detect the presence of arsenic 
in a case of suspected poisoning? 

First obtain the contents of the stomach by causing vomiting, if that 
has not occurred, or by the use of the siphon tube. A portion of the 
material thus obtained is carefully examined under the microscope for 
solid arsenious oxid. 

Reinsch's test is applied to another portion as follows: The portion 
taken is acidulated with about one-seventh its volume of hydrochloric acid, 
a clean piece of metallic copper-foil placed in the solution, and the whole 
heated and kept almost at the boiling-point for several minutes. In this 
hot solution the arsenic is deposited on the copper-foil as a grayish or 
black coating. The foil is taken from the solution and carefully washed 
with water, then pressed (not rubbed) between filter paper to free it from 
adherent moisture, and finally completely dried by being warmed on a 
piece of filter paper held quite a distance above a Bunsen flame. It is 
then placed in a constricted glass tube near the contracted part, the tube 
inclined, and the part containing the foil gently heated. Volatilization of 
the arsenic and combination with oxygen of the air take place, and colorless 
octahedral crystals of arsenious oxid are deposited in the cooler constricted 
part of the tube, which are readily recognized by means of the microscope. 

Another portion may be tested by Marsh's test (see page 67). 

State the forms in which arsenic occurs in nature. Describe 
a method of preparing As 2 3 . 

Arsenic occurs in nature in combination with iron, cobalt, nickel, and 
sulfur. With sulfur, As 2 S 3 , it is called orpiment, and As 2 3 , called 
realgar. 

As 2 3 is prepared by roasting an ore or compound of arsenic in air 
and condensing the resultant vapor. 

What salt of iron is used as an antidote for arsenic poisoning? 
State how this salt may be rapidly prepared. 

Freshly prepared hydrated sesqui-oxid of iron with magnesium. 

By adding calcined magnesium to a solution of ferric sulfate, 
washing the precipitate with water and squeezing out the moisture in 
a cloth. 

Name three salts of iron and place the chemical formula after 
each. 

Ferric chlorid, FeCl 3 ; ferrous sulfate, FeS0 4 ; ferrous carbonate, 
FeC0 3 . 



What Is arsenic? Hon obtained? (Mvo Its poisonous offsets 
and antidotes. 

\: i \ I i nhydrid or i obtained 

i>v subjecting the sweepings from the flu< wbli 

madon, when pure arsenic results m a sublin 

It i^ a corrosive poison snd causes irritation oi tf" tins] 

tract The symptoms beis et, metallic, but i 

companied by a burning sensation of the alimentary canal, vomiting, 
thirst, snd nervous symptoms. 

Antidotes an- freshly prepared hydrated sesqui oxid <>f iron with 
magnesium. Dialized iron is used as a local antidote on the gum ti 

Describe Marsh's test tor arsenic and give the equations 
occurring in the reaction. 

Pure metallic sine i> placed in a llask with dilute pure sulfuri< sdd, 
snd the hydrogen thus produced is passed through a drying tube contain- 
ing calcium chlorid, ami through a reduction tube <»i hard glass, free from 
lead, until the apparatus is completely filled with hydrogen. 

The unconstricted portion of the tube is heated to redness for about 
fifteen minutes. If no brown or black deposit i> produced in the con- 
stricted part oi the tube in advance of the part heated, the materials used 
may be considered free from arsenic. A small quantity of the arsenic 
solution is then introduced into the funnel-tube attached to the flask and 
washed into the tlask with a little dilute sulfuric acid. The arsenic unites 
with the nascent hydrogen, forming hydrogen arsenid gas, which, coming 
in contact with the heated part of the glass tube, decomposes with the pro- 
duction of a brown to black, metallic-like deposit of arsenic. 

Instead of heating the tube, the gas may be ignited as it issues from the 
tube and brought in contact with a cold porcelain surface, when the same 
deposit occurs. 

Antimony yields similar results and may be distinguished from arsenic 
by the deposit being insoluble in sodium hypochlorite, while arsenic is 
soluble. 

Give a test for antimony, gold. 

Test for antimony: Acidify a solution of antimony and add hydro- 
gen sulhd, an orange-red precipitate of sulfid of antimony forms. 
The precipitate is soluble in ammonium sulfid. 

Test for gold: Add hydrogen to a solution of gold; a brown precipi- 
tate of auric sulfid is formed, which is soluble in yellow ammonium 
sulfid. 

State the chemical action that causes teeth clasped with 
gold to decay beneath the gold more quickly than those clasped 
with rubber. 

There is a constant formation of minute quantities of sulphur dioxid 
from the sulphur in the rubber clasp which exerts an antiseptic influence. 
This is lacking in the gold and the bacteria can multiply more readily. 

Name four solvents commonly used to liquefy solids for 
chemical analysis. Mention the precautions necessary. 



68 PHYSICS AND CHEMISTRY 

Water, hydrochloric acid, nitric acid and nitro-hydrochloric acid. 
The substance should be finely powdered. Sufficient time should be 
allowed and too large an excess of acid avoided. 

Define neutralization and explain its importance in analytic 
chemistry. 

Neutralization consists in adding a sufficient quantity of an acid to an 
alkali or alkali to acid to produce a neutral action. If is of great value in 
quantitative analysis. Knowing the amount of acid required to neutralize 
a given amount of an alkali, we may determine the amount of an alkali in 
a solution by adding acid until the solution is neutralized and noting the 
amount of acid used. 

State how chemical antidotes and physiological antidotes 
differ in their action. 

Chemical antidotes act by neutralizing the reaction or changing the 
chemical composition of the poison itself. Physiological antidotes act 
by counteracting the effect of the poison on the tissues or system. 

ORGANIC CHEMISTRY 

What is organic chemistry? State the general properties 
of organic compounds. 

Organic chemistry is the chemistry of the carbon compounds; or it is the 
chemistry of the hydrocarbons and their derivatives, including cyanogen 
and its compounds. 

Properties: Organic compounds contain carbon and therefore, upon 
burning, char. When pure they are completely consumed under con- 
tinued heat; any residue remaining after the disappearance of the char 
indicates the presence of mineral matter. They are the essential com- 
pounds of plant and animal structures and their molecular composition 
may be very complex, but includes only a few elements. 

Differentiate between hydrocarbons and carbohydrates. 

Hydrocarbons are compounds of hydrogen and carbon, as CH 4 , 
methane; C 2 H 5 , ethyl. 

Carbohydrates are organic compounds composed of carbon, hydro- 
gen and oxygen, the latter in the same atomic proportions as in water. 
Example: glucose, (C 6 H 12 6 .) 

Name the principal derivatives of the hydrocarbons. 

Alcohols, ethers, chloroform, iodoform, aldehyds, and fat acids. 

Name four elements that enter into the formation of most 
organic bodies. 

Carbon, hydrogen, oxygen, and nitrogen. 

(a) Give the formula, (b) occurrence in nature, (c) the 
properties, and (d) uses in medicine of salicylic acid. 

(a) HC 7 H 5 3 . 

(b) Salicylic acid is found in oil of wintergreen (gaultheria) as methyl 
salicylate, and in coal-tar. 

(c) It occurs as fine, white, needle-shaped crystals, odorless, sweetish, 



\ ! [OH \M' PI HI ! V 

acrid taste, sparing]} loluble in water, soluble In ah ohol, ether, and i hloro- 
form. 

(I) h la uaed a^ an 
i preservative. 

Qive the d i ff er ence b etw ee n essential volatile <>iN and 

fixed oils. (ii\e examples <>t each. 

/ | n /:.';.:/ Otli arc the oflfl of plants and belong tfl tin- I lai lof i OmpOtUldi 

known m terpenes. They bave the formula C l# H t9l and are volatile 

liquids. They do not form glycerin when treated with an alkali. 

Examples: oil ol turpentine, lemon, bergamot, juniper, and rosemary. 

Fixed oils arc the true fats and art- composed of the glyceryl radical 

combined with a fat add radical. When teated with an alkali they form 
glycerin and soap. Examples: stearin, palmitin, olein. 

What is turpentine and what is its source? 

Turpentine is a terpene (essential oil) obtained from the juice of the 
pine. 

What is camphor, chemically. Give its source and properties. 

Camphor, C I0 H lfl ( >, is a volatile, oxidized, essential oil belonging to the 
class of compounds called .stcaroptens or camphors. It is obtained from 
the camphor tree. It is used as an antispasmodic, carminative, and cardiac 
stimulant. 

Name some camphors used in medicine and give the source 
from which they are derived. 

Camphor, from the camphor tree; menthol, from the oil of peppermint; 
thymol, from the oil of thyme; cucalyptol, from the oil of eucalyptus. 

FERMENTATION AND PUTREFACTION 

Differentiate between fermentation and putrefaction. 

Fermentation is the decomposition of an organic compound into simple 
more stable substance by the action of an enzyme or ferment. 

Putrefaction is the decomposition of dead nitrogenous organic sub- 
stances under the action of bacteria, with the generation of more or less 
offensive odors. 

What foods undergo lactic acid and butyric acid fermen- 
tation? 

Carbohydrates, milk, and butter. In milk lactic acid is produced by 
the action of Bacterium lactis on the lactose. 

(a) C 12 H,,O n + H 2 = 2C 8 H 12 O e . 

Lactose. Glucose. 

(b) 2C 6 H 12 6 - 4C 3 H fl 3 . 

Glucose. Lactic acid. 

Butyric acid fermentation is an advanced stage of lactic acid fermenta- 
tion, and takes place in milk and butter. In butter it is due to the splitting 
of butyrin by the fat-splitting enzyme into butyric acid and glycerin. 



70 PHYSICS AND CHEMISTRY 

2 C 3 H 6 3 = C 4 H 8 2 + 2 C0 2 + H 2 . 

Lactic acid. Butyric acid. 

C 3 H 5 (C 4 H 7 2 ) 3 + 3 H 2 = 3 C 4 H 8 2 + C 3 H 5 (CH) 3 . 

Butyrin. Butyric acid. Glycerin. 

Give (a) the formula, (b) sources, (c) properties, and (d) 
the uses of acetic acid. 

(a) HC 2 H 2 3 or CH 3 COOH. 

(b) A cetic acid is obtained from the destructive distillation of wood and 
the fermentation of alcohol. 

(c) It is a colorless liquid having a strong, pungent, vinegar-like odor 
and an acid taste. It unites with bases to from salts called acetates. 

(d) It is used as a refrigerant, astringent, and excitant; a mild caustic 
for softening and removing callous tissue; a solvent, and disinfectant. 

Name four organic acids. 

Acetic acid, lactic acid, oxalic acid, citric acid. 

Give the formula of acetic and oxalic acids. 

Acetic acid = HC 2 H 3 2 ; oxalic acid = H 2 C 2 4 . 

ALCOHOLS 

What is an alcohol? 

An alcohol is the hydroxid of a hydrocarbon radical, as methyl alcohol, 
CH 3 OH. 

What is ethyl hydrate? Give its formula and state how it is 
produced. 

Ethyl hydrate (ethyl hydroxid, ethyl alcohol, grain alcohol) is ordinary 
(common) alcohol composed of the ethyl radical united to the hydroxyl 
group. Formula: C 2 H 5 OH. 

It is produced by the fermentation of sugars in solution. 

What is the chemical designation of ordinary alcohol of 
commerce? 

Ethyl hydroxid. 

What are some of the substances from which ordinary 
alcohol is derived? Describe the chemical process of the prep= 
aration of alcohol. 

Sugars, by fermentation; grain, as corn, oats, rye, barley, which must 
first undergo germination to change the starch into sugar; then fermenta- 
tion, the alcohol being finally separated from the mixture by distillation. 

What are the differences between common alcohol and abso= 
lute alcohol? 

Common alcohol. Absolute alcohol. 

Per cent., by weight, of water about 9. Not more than 1. 

Specific gravity at 15. 6° C 0.820 Q-797 



• 111 I 

Name some <>f the contaminations of alcohol and hou th- \ 
ina\ be detected. 

i. / , composed largely of amy alcohol, with other sul 

>uld be perceptible when the I tloobol In 

rture of to cc. ah ohol with i rin bai 

orated spontaneously from ■ piet e oi ( Kan, odorless blotting paper. 

What is methyl alcohol? what are Its properties and uses? 

Methyl alcohol (wood alcohol, wood .spirit), (II .» )ii. i , i produ< ' oi 
the destructive distillation of wood. It is a light, colorleai liquid baTing 
i characteristic, disagreeable odor, misdble with water in all proportions, 
and poisonous. Its vapor is explosive. 

It is used as a Bolvent for fats, oils, camphor and resins; in the manu- 
facture oi varnishes and organic dyes; and for heating purpo i 

ETHER 

What is understood by the group of chemical substances 
known as the ethers? 

Ethers are ozids of hydrocarbon radicals, or they may be considered 

after the type of water in which both atoms of hydrogen have been replai ed 

by an alcohol radical. 

Example: H O II, water, 

CjH, O C 2 H 5 , or (C 2 H 5 ) 2 0, ethyl ether. 

State formula of (a) ethyl alcohol, (b) sulphuric ether, (c) 
acetic acid. 

(a) C 2 H 5 OH (b) (C 2 H 5 ) 2 (c) HC 2 H 3 2 . 

Describe ethyl oxid, giving the ordinary name, formula, 
derivation, and mode of production, with reactions occurring. 

It is a transparent, colorless, mobile liquid with a characteristic odor 
and a burning, sweetish taste. It boils at 35 C, its vapor being very 
intlammable. Its ordinary name is ether, sometimes called sulfuric ether 
and ethyl (ethylic) ether. Formula: (C 2 H 5 ) 2 0. 

It is derived from alcohol by the dehydrating action of sulfuric acid. 
Production: Bv distilling a mixture of alcohol and sulfuric acid at about 
140 C. 

C 2 H 5 OH + H 2 S0 4 = C 2 H 5 HS0 4 + H 2 0. 

Alcohol. Sulfovinic acid. 

C 2 H 5 HS0 4 + C 2 H 5 OH =(C 2 H 5 ) 2 + H 2 S0 4 . 

Ether. 

From what substances is ether obtained? 

Alcohol and sulfuric acid (see preceding question, Production). 

CHLOROFORM 

What is chloroform, chemically, and how is it made? 

Chloroform (trichlormethane, formyl chlorid) is methane, CH 4 , in 
which three atoms of hydrogen have been replaced by three atoms of 



72 PHYSICS AND CHEMISTRY 

chlorin, yielding CHC1 3 . It is prepared by the action of chlorinated 
lime (bleaching salt of lime) on ordinary alcohol or acetone or (the 
purest) from chloral. 

Give the composition and properties of chloroform. 

Formula, CHC1 3 . 

It is a heavy, colorless, volatile liquid having a burning, sweetish taste 
and characteristic odor. Its specific gravity is 1.476 at 25 C. It is not 
inflammable, but its vapor, when heated, burns with a green flame. It 
boils at 6o° C. It is a solvent for many substances, as fats, oils, alkaloids. 
It is employed in medicine as an anesthetic, sedative, and externally as a 
local irritant. 

IODOFORM 

What is the chemical name and formula of iodoform and of 
what is it a derivative? 

Its chemical name is tri-iodomethane (formyl iodid). Formula: CHI,. 
It is a derivative of methane, CH 4 , in which three atoms of hydrogen 
have been replaced by three atoms of iodin. 

How is iodoform prepared? Give its properties and uses 
in medicine. 

Iodoform is prepared by boiling a solution containing potassium 
hydroxid, potassium iodid, iodin, and alcohol or acetone. It occurs in 
bright yellow, hexagonal crystals, having a penetrating, disagreeable odor. 
It is msoluble in water, but soluble in alcohol and ether. Iodoform is 
extensively used in surgical dressings for its antiseptic and local anesthetic 
properties. If used too freely it may cause poisoning from the liberation 
and absorption of iodin. 

Define decay and give an example. 

Decay is the decomposition of organic bodies by slow oxidation, with- 
out increase in the temperature. Example: Wood exposed to the air in 
the presence of moisture slowly oxidizes into C0 2 and H 2 0, leaving a 
slight residue. 

What chemical changes take place in decaying bodies? 

Various gases are produced, dependent upon the composition of the 
decaying body, as C0 2 , H 2 0, NH 3 always, and H 2 S or (NH 4 ) 2 S if sulfur 
is present; H3P if phosphorus is present. 

Give the definition and the graphic formula of a phenol. 

A phenol is a substitution compound of benzene in which one or more 
atoms of hydrogen of benzene have been replaced by the hydroxyl group, 
(OH). 

OH 



C 6 H 4 (OH) 2 , resorcin. 







101 

(ii\c I flu- composition, (1>) s\non\ms, | properties, .uul 

(ii the mode ol manufacture of carbon* scld« 

I Hull. 

(b) Phenol, hydroorybensene, photic acid, phenyls a< 

Puit corboli curs In the form <>t ooloiit rhich 

.ire deliquescent and soluble in water, glycerin, and ii\<«l ofla. The 
common lal variety Is a pink to dark red or brown liquid. It hasanodof 
like that of creosote, and .1 burning, caustii taste, it firs! causes blanch- 
ing of mucous membranes and finally an est liar. It has germu /</<//, anti 
septic x and slight local anesthetic properties. The salts are termed 
"phenates," "phenylates," or "carbolati 

(d) Heavy oil of coal tar is distilled between 165* ('.and [90 C, and 
the distillate treated with 1 austic soda, which forms .sodium c arbolate. it 

is further purified, and just BUffidenl sulfuric 84 id is added to set fp 

carbolic acid. Carbolic add may DC obtained by the distillation of . 
tar and by various synthetic methods. 

Give the formula of carbolic acid and mention an antidote. 

Carbolic acid, C 6 H 5 OH. Antidote, alcohol. 

(a) What is creosote? (b) How is it prepared? (c) De- 
scribe its properties and (d) give its uses. 

(a) Creosote is a complex mixture of phenols, especially guaiacol 
creosol, and cresol. 

(b) It is obtained by distilling wood-tar or coal-tar. 

(c) It is a yellow or brownish, oily liquid with a smoky odor and burn- 
ing taste, soluble in one hundred and fifty parts of water, freely soluble in 
other solvents, except glycerin. 

(d) It is used locally for toothache and as a caustic for warts. Mostly 
used for its antiseptic properties. 

Distinguish creosote from carbolic acid. 

Creosote is less soluble than carbolic acid, is not crystalline, does not 
coagulate collodion, and with ferric chlorid gives a transient brown, 
instead of a violet color. 

State the most important substances found in coal tar. 

Carbolic acid, acetic acid, ammonia, aniline, benzine, naphthalene, and 
paraffin. 

What is meant by denatured alcohol? For what purposes 
may it be used? 

Denatured alcohol is ethyl alcohol which has been rendered unfit 
for drinking by the addition of other substances; i. e., usually benzine 
and wood alcohol. It may be used as a fuel in alcohol lamps, but not 
internally. 

What is phenol? How is it obtained? What uses are made 
of it in dentistry? 

Phenol is carbolic acid, C 6 H 5 OH. It is obtained during the distilla- 
tion of coal tar between the temperatures of 170 and 190 C. By frac- 



74 PHYSICS AND CHEMISTRY 

tional distillation of this crude phenol, pure carbolic acid is obtained, 
which forms colorless, interlaced, needle-shaped crystals, sometimes 
acquiring a pinkish tint. In dentistry it is used to sterilize cavities pre- 
vious to inserting the filling material, as an antiseptic in the treatment of 
putrescent canals and alveolar abscess, for the devitalization of deciduous 
pulps, as an escharotic, etc., etc. 

Describe the action of chlorin on alcohol. 

Chlorin either removes the hydrogen or replaces it when brought 
in contact with alcohol. 

PETROLEUM 

What is petroleum (coal oil)? What important derivatives 
of petroleum are used in medicine? 

Petroleum or coal oil is the product of the decomposition of the remains 
of fish and other sea animals deposited in the earth. It is a mixture of 
various compounds, chiefly of the methane series, as paraffins. 

Its derivatives used in medicine are: petrolatum (petrolatum molle, 
petrolatum spissum, known by the trade names of cosmolin, vaselin, etc.) ; 
petrolatum album; petrolatum liquidum. The last has recently come 
into use as a laxative. 

What is the source, principal properties, and uses in medicine 
of vaselin? 

Vaselin is obtained from petroleum by distilling ofl the lighter and more 
volatile portion and purifying the residue. It is a fat-like mass, of a white 
to yellowish color, having a slight fluorescence, tasteless, and odorless, but 
when heated giving off a faint petroleum-like odor. It is used for its 
protective properties in dressing sores, in skin affections, and as a base for 
ointments. Internally, it is used for its soothing effect in gastro-intestinal 
irritation. 

To what class of organic compounds does glycerin belong? 
Give its formula. Where does glycerin exist in nature, and 
from what source is it obtained? 

Glycerin is a triatomic alcohol. Formula: C 3 H 5 (OH) 3 . It exists in 
combination in fats, being the basic part of the fat. It is obtained by the 
action of superheated steam, an alkali, or an enzyme upon fats, thus caus- 
ing a splitting of the fat in a fatty acid and glycerin. 

How is collodion prepared and what are its uses? 

Pyroxylin, 4 gm. ; ether, 75 cc; alcohol, 25 cc. 

The ether is added to the pyroxylin in a suitable vessel and allowed to 
stand fifteen minutes; then the alcohol is added and the mixture shaken 
until the pyroxylin is dissolved. It is used as a protective to the abraded 
skin and as a basis for photographic sensitized films. 

(a) What is the formula and source of tartaric acid? (b) 
What is its use in medicine? (c) What double salts of this 
acid are used in medicine? 

(a) H 2 C 4 H 4 8 . Tartaric acid is a constituent o£ many plants and 



&LKAL01 75 

fruits, especially grapes, ind Is obtained from tin- dep 

tartar, Which i> Impure | no bitartrafc I, <»< * iirnng In 1 1 » « - i » r 1 1 . 

tion of wine. 

il>) it is i hi Mt reducing agent, but rai I tlone. It is used In 

conjunction with sodium bicarbonate In the preparatJon of effenn 

salts or miztUI 

(c) 1 tartrate \ Km belle salt ), k\.i< 11/ 

um tartrate (tartar emetic), »K(SbO)C 4 H 4 0, n ,0. 

(ii\e the formula, OCCUITence in nature, ami source of I 
citric add, ib) oxalic acid, c) lactic acid, ami d hen/oic acid. 
H,c\,ll(), • ll.O. Citric acid occurs free in lemons, currants, 
raspberries, cranberries, and gooseberries, and is obtained mostly from 
lemon-juice. 

v l>) BjC,0 4 • :11,0. Oxalic add is present in many plants, as rj 

and sorrel, in the form of the potassium salt; in rhubarb, beets, etc., as the 

calcium salt. It also OCCUIS in the urine of man as a salt under certain 
conditions. It is obtained from rhubarb, but mostly preparted artificially 
from SUgai by the action iA nitric acid or from sawdust by the action of 
caustic soda. Antidote = chalk or soluble salt of calcium. 

(c) C 3 H 6 3 . Lactic acid is found in opium, ensilage, sauerkraut, 
gastric juice, sour milk, koumiss, and as sarcolactic or paralactic acid in 
muscle, extract of beef, blood, and sometimes in urine. It is produced by 
the fermentation of sugar. 

(d) HC 7 II.0 2 . Benzoic acid is present in gum benzoin and the urine 
of herbivora. It is obtained from benzoin, but is chiefly prepared arti- 
ficially. 

What organic acids are present in vegetables and fruits? 

Tartaric, citric, oxalic, malic, tannic, etc. 

ALKALOIDS 

Define an alkaloid and (a) name three principal ones used 
in medicine. 

An alkaloid is a nitrogenous organic basic principle of vegetable or 
animal origin, giving, in most instances, to the body from which it is de- 
rived, its characteristic physiologic properties. 

(a) Quinin, strychnin, and morphin. 

Mention three alkaloids, giving their uses in dentistry. 

Cocain: As cocain hydrochlorid in solution for local anesthesia. 
In this form it is used to extirpate pulps, extract teeth, and for minor 
operations. 

Morphin: As acetate or sulfate, usually mixed with arsenic as 
a devitalizing mixture for pulps, or with carbolic acid and oil of cloves as 
an obtundent. 

.{tropin: As sulfate usually administered internally in treatment of 
neuralgia. 

What elements enter into the composition of all alkaloids? 



76 PHYSICS AND CHEMISTRY 

Carbon, hydrogen, and nitrogen in volatile or liquid alkaloids, asconiin, 
nicotin, spartein. Carbon, hydrogen, nitrogen, and oxygen in fixed or 
solid alkaloids, as morphin, strychnin. 

Give the general properties of alkaloids. 

They are liquids or solids, having basic properties and many reactions 
like ammonia, combining directly with acids, without the displacement of 
hydrogen-forming salts. Most of them are crystalline, white, with a 
bitter taste, and odorless, except those which are volatile. They are 
insoluble in alkalies, only sparingly soluble in water, but readily soluble 
in alcohol, ether, chloform, benzene, petroleum ether, and amylic alcohol. 
They are all more or less toxic 

Name five alkaloids, giving the derivation of each. 

Strychnin from nux vomica; morphin from opium; atropin from bella- 
donna; quinin from cinchona bark; cocain from erythroxylon coca. 

What is a poison? 

A poison in any substance producing deleterious effects upon the 
animal organism. The poison may be (1) taken into the body and 
absorbed; (2) it may act directly on the parts with which it comes in 
contact — direct chemical action; (3) it may be applied externally, and 
enter the circulation. 

How may poisons be classified? Give the manner of action 
of each class. 

Irritant poisons produce irritation and inflammation of the stomach 
and intestines, attended or followed by intense pain in these parts, tender- 
ness of the abdomen, and violent vomiting and purging, the material 
evacuated being often tinged with blood. They may be of mineral, 
vegetable, or animal origin. 

Narcotic or cerebral poisons act principally on the brain and spinal 
cord, more especially on the former. They induce headache, vertigo, 
stupor, visual disturbance, delirium, insensibility, paralysis, convulsions, 
and coma. 

Narcotico-irritant poisons partake of the action of both the irritant 
and narcotic poisons. 

Give an example of (a) irritant, (b) narcotic, and (c) nar- 
cotico-irritant poisons. 

(a) Arsenic, from mineral; gamboge, from vegetable; cantharides, from 
animal. 

(b) Opium and hydrocyanic acid. 

(c) Strychnin and brucin. 

Upon what theory are eggs given in cases of poisoning with 
corrosive sublimate? 

Upon the theory that the albumin of the eggs forms an insoluble al- 
buminate of mercury. 

What are the antidotes for poisoning with (a) copper sulfate, 
(b) oxalic acid? 



P01 

tasslum f< i and albumin 

(1)) Lime water or preferably chalk; d 

Name the cliciiiic.il antidotes f6f poisoning \Nith I mineral 

m ids, uid b «. auatk alkaJies. 

Magnesium oxid, chalk, lime, nap, an. 1 albumin. 
(l>) Fata or oils; vinegar or a» etic a* id well diluted with irater;len 

juice v i itric acid). 

■ State the most common aiul comcniciit antidotes for 
poisoning with mineral acids. h State the course t<> be pur- 

stied when the poison to be antJdoted is unknown. 

Magnesium oxid; alkaline carbonates, as sodium bicarbonate; 
chalk, soap; these to be followed with Eats, oils, eggs, milk, and Sour. 
[\)) Produce emesia with mustard, zinc sulfate, or apomorphin hydro 

chlorid hvpodermicallv, or empty the Btomacfa with the stomal h -pump or 

siphon tube. If an alkaloidal poison is suspected, give tannic add <>r 
permanganate oi potassium. Thoroughly wash out the stomach with a 
mucilaginous solution or sodium bicarbonate. Apply artificial heat to 
the body, stimulate with ammonia, whiskey, strong coffee, and treat the 
symptoms as they arise. 

Mention a chemical antidote for sulfuric acid and explain 
the action of this antidote. 

Magnesium oxid. It neutralizes the sulfuric acid with the formation 
of magnesium sulfate and water, accompanied by the evolution of but 
little heat and no gas. 

What are the antidotes for nitric acid and hydrochloric acid 
poisoning? 

Magnesium oxid (calcined magnesium), alkaline carbonates, soaps, 
oils, and albumin. 

What is cellulose? Give the properties of cellulose. 

Cellulose is cotton. It is a soft, white fleecy mass, formed in a pod on 
the cotton plant. When treated with nitric and sulfuric acids gun cot- 
ton, trinitrocellulose, C 6 H 7 (X0 2 ) 3 5 , or denitrocellulose, C 6 II s (N0 2 ) 2 5 
(pyroxylinum), is formed, which compounds are highly explosive. 

Mention the antidotes applicable in a case of poisoning from 
iodin. 

Starch, demulcent drinks of flaxseed tea, elm bark; or gruel, milk, and 
white of egg. 

What antidotes should be used in phosphorus poisoning? 
Explain the action of each? 

Copper sulfate in solution. It quickly coats the phosphorus with a 
black deposit, said to be copper phosphid, which is insoluble in the di- 
gestive fluids. 

Turpentine, preferably the French variety, which is old and has become 
ozonized. It produces some oxidative product of phosphorus which is 
nonpoisonous i * comparatively free from toxic action. 



78 PHYSICS AND CHEMISTRY 

What is the antidote for poisoning with hydrocyanic acid? 

Freshly precipitated hydrated ferric oxid, or ferric hydroxid with mag- 
nesium oxid, which forms Prussian blue, an inert substance. Inhalation 
of ammonia or chlorin, with cold effusion to the face, should always be 
employed with the iron compound. 

What is the chemical treatment for carbolic=acid poisoning? 

The chemical antidote is any soluble, nonpoisonous sulfate, as Epsom 
salt (magnesium sulfate), sodium sulfate, or potassium sulfate. As these 
act only upon the carbolic acid in the blood, forming nontoxic phenol- 
sulf ates (sulf ocarbolates) , the chemical antidote should be preceded by the 
free use of alcohol, which allays the irritation, and the stomach rapidly 
emptied by administering a hypodermic injection of apomorphin hydro- 
chlorid. 

Name five common vegetable poisons and give the antidote 
for one of them. 

Opium, belladonna, nux vomica, digitalis, and aconite. 
Opium: Antidote, potassium permanganate; atropin, caffein. 

Give the (a) chemical, and (b) physiologic antidote for 
morphin and strychnin. 

(a) Morphin: potassium permanganate, tannic acid. Strychnin: tan- 
nic acid, iodin with potassium iodid. 

(b) Morphin: atropin or tincture belladonna, caflein (coffee). Strych- 
nin: chloral, potassium bromid. 

PHYSIOLOGIC CHEMISTRY 

Define physiologic chemistry. 

Physiologic chemistry is the study of the chemical properties of the 
tissues, the secretions and excretions of the body, and of foodstuffs, the 
chemical changes which occur in their transformation into living tissue, 
and their ultimate fate. 

Name the principal substances composing the human body. 

j ■ f Water, 

• \ Mineral substances: calcium phosphate, calcium carbonate, etc. 

x-v • f Nonnitrogenous compounds: carbohydrates and fats, 

rganic | Nitrogenous compounds: albumins and hemoglobin. 

Define the terms metabolism, catabolism, and anabolism. 

Metabolism embraces the various chemical changes occurring in the 
living body, due to the action of enzymes, bacteria, and the living cell 
activity. 

Catabolism {destructive or analytic metabolism) is the process which 
changes complex bodies into simpler ones, as occurs in the digestive and 
respiratory processes. 

Anabolism {constructive or synthetic metabolism) is the process which 
builds up more complex bodies from simpler ones, as ocnirs in the con- 
struction of tissues by the living cells from the absorbed di< stive products. 



PH\ 

Describe the chemical process In which minerals an CM" 
\crtcd IntO animal foods. 

Water lia\ : bed DftOr "ii dfolj 

ammonia salts, and stea, phosphates .ukI sulphates «>i p<>t.i 

calcium, etc., enters the plant through the roots by .1 simple pr« >»<•-. > «.f 
diffusion, and ia carried to the various green parts of the plant (chiefly 

Id the leaves), where, under the inlluent e »>t' Sunlight, « hi-rnit aJ 

sition and the formation ^\ new compounds, Organic in nature and of 

more complex formul.e. This action is a! companied by the 

liberation of oxygen. These organic compounds, thus formed, 
changed in the animal eating tin- plants, back to such inoi 
phoftphatesj carbonates, Bulfates, etc 

Mention the chief substances that serve as plant food. 
Water, CO,, ammonia, potassium, and sodium Baits, phosphan 
calcium and magnesium, silicates of sodium and potassium. 

Differentiate, from a chemical standpoint, animal life and 
vegetable life. 

Chemical changes in the plant are progressive or constructive, while 
in the animal they are, as a rule, retrogressive or destructive. 

The products of plant activity are usually crystalline, while those of 
animal activity are usually fibrous or cellular. 

What elements enter into the animal system as necessary 
constituents? 

Sodium, potassium, iron, sulphur, prosphorus, oxygen, hydrogen, 
nitrogen, calcium, magnesium, chlorin, and carbon. 

Mention three groups of organic substance chiefly used as a 
food by animals. 

Fats, proteids, and carbohydrates. 

Define and illustrate osmose (osmosis). 

Osmose (impulse) is the force by which liquids are driven through a 
moist membrane or other porous septum in endosmotic and exosmotic 
actions. 

Example: When a dialyzer containing alcohol is suspended in water, 
the liquids pass through the porous septum and intermingle. More 
molecules of water pass into the alcohol (endosmose) than of alcohol 
into the water (exosmose). 

What are the properties and uses of glucose? State its 
importance in medical chemistry. 

Glucose is a white or yellowish -white crystalline solid, having a sweet 
taste and freely soluble in water. As found in commerce it is usually a 
colorless or faintly yellowish, syrupy liquid, in which form it is very impure. 
It polarizes light toward the right, reduces cupric salts, and with yeast 
ferments into carbon dioxid and alcohol. It is used as a substitute for 
cane-sugar, as in the manufacture of candy and artificial honey. It is 
the final product of the digestion of carbohydrates and is present in the 
urine in diabetes mellitus. 



80 PHYSICS AND CHEMISTRY 

Describe two tests for glucose. 

Fehling's Test: Take i cc. of Fehling's solution diluted with about 
4 cc. of water and boil; when glucose in solution is added and the mixture 
again boiled, a yellow precipitate of cuprous hydroxid, or a red precipitate 
of cuprous oxid is formed. 

Nylander's Test: About 10 cc. of a solution of glucose mixed with 
about i cc. of Nylander's reagent (bismuth subnitrate, 2 parts; Rochelle 
salt, 4 parts; and caustic soda, 8 per cent, solution, 100 parts) and boiled, 
yields a grayish-brown to black color. 

Describe the fermentation test and Trommer's test for 
glucose in the urine. 

Fermentation Test: Compressed yeast is mixed with some urine and 
placed in a saccharometer tube, such as Einhorn's, and then allowed to 
stand until the glucose present ferments, yielding carbon dioxid, which 
collects at the top of the tube. 

Two control tests should be made, one with yeast and water, and 
another with yeast and normal urine. The volume of gas (if any) pro- 
duced is compared with that obtained with the urine under examination. 

Trommer's Test: To about 10 cc. of the urine in the test-tube about 
one-fourth its volume of sodium or potassium hydroxid is added, and then 
copper sulfate solution, drop by drop, shaking after each addition, until 
the precipitate of cupric hydroxid produced is no longer dissolved. The 
upper part of the tube is then heated, when a yellow precipitate of 
cuprous hydroxid or a red precipitate of cuprous oxid will be produced if 
glucose be present. The unheated portion remains unchanged. 

Give the chemical meaning of the term sugar. 

Sugar is a generic name applied to all carbohydrates possessing sweet- 
ening power. 

What is (a) starch, (b) dextrin, and (c) how are they con=» 
verted into grape=sugar? 

(a) Starch — amylum (C 6 H 10 O 5 ) n — is a white, odorless, and tasteless 
powder, consisting of small granules which have a stratified structure, 
and vary in shape and size in different plants. It is insoluble in cold 
water. When boiled in water the granules swell and burst, and a homo- 
geneous white paste is formed. 

(b) Dextrin (British gum) (C 6 H 10 O 5 ) n is an amorphous, white or 
yellowish powder having a slightly sweetish taste and readily soluble 
in water. Its concentrated solution is viscid and sticky, similar to gum 
solutions. 

Both starch and dextrin are carbohydrates and belong to the poly- 
saccharid group. 

(c) They are converted into grape-sugar (glucose) by the action of 
ptyalin, amylopsin (amylase), or dilute mineral acids. 

How is starch obtained? (a) How may starch be recognized 
chemically? (b) What substance is formed when diastase, 
ptyalin, amylopsin (amylase), or dilute acids act upon starch? 



St. m h may l>e obtained i and then wa 

the Man h n [to i old water. 

Starch jriddfl with iodin solutioi oloi 

^li) It ir> i hanged into 

Distinguish between Man.li ami sn^ar. I l'»\ what his- 
tologic element is starch Converted into BUgftlT 

Sugar (cane-sugar) * l2 ,Il (>,,, is a colorless, udorli 

line solid. It is verv soluble in water, fa solutions rotate polari/ed light 
toward the right It yields no eolor with iodin. 
(a) By ptyalin (ptyalasc) and amylopsin (aniyla 

Differentiate grape-sugar and cane-sugar. iai How is the 
latter converted into the former? 

Grape-sugar (glucose), see page 70, last question. 
Cane-sugar, see preceding question. 

(a) By the action of ptyalin, amylopsin. or dilute mineral acid under 
favorable conditions it is hvdrolyzed into glucose. 

Write the formula of starch and mention the class of chemical 
compounds to which it belongs. State the reaction of starch. 

Starch is a carbohydrate. Formula, C 6 H 10 O 5 . It is neutral in re- 
action. 

Mention three chemical varieties of sugar and give their 
sources. 

Cane-sugar, derived from sugar cane. 
Grape sugar (glucose) derived from fruit. 
Milk sugar (lactose) from milk. 

What chemical product of bacteria is present in dental caries? 
(a) Does this product act on the mineral salts of the teeth? 
(b) If so, how? 

Lactic acid, (a) It does, (b) It forms soluble salts which are dis- 
solved and washed out. 

FATS 

Define fats and give the names and formulas of three fats. 

Fats are compounds of the glyceryl radical and a fat acid radical; 
formed by glycerin and a fat acid. 

Stearin (tristearin, glycerid of stearic acid), C 3 H s (C 18 H 35 0,) 3 . 
Palmitin (tripalmitin, glycerid of palmitic acid), C 3 H 5 (C 18 H 3l 2 ) 3 . 
01 tin (triolein, glycerid of oleic acid), C 3 H 5 (C 1S H 33 2 ) 3 . 

Define emulsion, saponification, and soap. 

Emulsion is a liquid in which oil in minute subdivision is suspended 
by means of some mucilaginous substance. 

Saponification is the process by which fats, when treated with an alkali, 
yield a salt of the fat acid and the metal called soap. 

Soap is a fat acid salt of various metals, usually potassium or sodium. 
6 



82 PHYSICS AND CHEMISTRY 

What are proteins? Give examples. 

Proteins (proteids) are very complex, unstable, mostly noncrystalline 
compounds comprising all albuminous substances, and are composed 
of C, H, O, N, and usually S. Examples: Egg albumin, fibrin, mucin, 
and gelatin. A few contain phosphorus and a few others iron. They are 
the nitrogenous food substances existing in animals and plants. 

(a) What are proteids? (b) From what are they derived? 
(c) Name the chief proteids. 

(a) Same as proteins (see preceding question). 

(b) They are derived from plants and animals. 

(c) Egg and serum albumin, proteoses (albumoses), peptones, and 
globulins. 

What is albumin? Name a substance containing albumin, 
(a) as a liquid and (b) as a solid. 

Albumin is a protein body composed of C, H, O, N, and S, having a 
very complex molecular structure, nondialyzable, nonassimilable, but 
transformed into soluble, dialyzable, and assimilable compounds by the 
digestive processes. It is the principal part of protoplasm in plants and 
animal cells and the most important nitrogen-containing food. 

(a) Milk. 

(b) Meat. 

What is mucin? Give its origin and a test by which its pres= 
ence in solution may be detected. 

Mucin is a compound proteid, either glycoproteid or nucleoproteid in 
character. It is colloidal, insoluble in pure water, but soluble in weak 
alkalies, not coagulated by boiling, but gives many of the reactions of the 
albumins. 

Mucin is secreted by the mucous glands, found in saliva, intestinal 
juice, connective tissue, and other parts of the animal body. 

It is precipitated from its solutions by acetic acid, insoluble in excess 
of the acid. 

Describe three tests for albumin. 

Xanthoproteic Reaction: A few drops of concentrated nitric acid are 
added to the solid albumin or its solution and boiled ; a yellow color results. 
On cooling and the addition of an excess of ammonium hydroxid a deep 
orange yellow color is produced. 

Millon's Reaction: Solid albumin or its solution, when heated with 
Millon's reagent (solution of mercuric nitrate containing nitric acid), 
yields a brick-red solid. 

Boiling (Coagulation) Test: When a solution of albumin is boiled, the 
albumin is coagulated, especially when one or two drops of nitric acid 
are added to the boiled solution. 

(a) In testing urine by heat in a case of suspected albuminuria, 
what substance might be precipitated and so make the test 
deceptive, (b) How may these substances be differentiated 
from the precipitate of albumin, and (c) how may they be 
separated from the urine before applying the test for albumin? 



• \ 1 1 \ \ 83 

! arlhv phosphates i.ahium and ni.i:'n. iurii ph( 
lb) Hv their .soluhility in nitrie .1* i< I . albumin i 

r, . rendering the urine alkaline with iodhun <»r ammonium by- 
droxid, allowing to stand a fen minutes, then filtering ofl the pre Ipltated 

earthy phosphates anil applying the i« albumin to tin- iiltrate. 

State the effect of /inc chlorid 011 alhimiin. What com- 

pound is formed? 

Zinc chlorid combines readily with albuminoid substances, forming 
insoluble albuminates, 

Mention the principal constituents of the several digestive 
secretions, anil pve the reaction of each secretion. 

Saliva: Ptyalin, albumin, nun in, and inorganic salts, as the chlorids, 

carbonates, sulfates of sodium and other metals, and potassium SUlfo- 

■ id. Reaction: Slightly alkaline. 

Gastric Juice: Pepsin, hydrochloric acid, rennin, lipase (a little), in- 
organic salts, as the chlorids and phosphates of sodium and other metals. 
Reaction: Acid. 

Pancreatic Juice: Trypsin (trypase), amylopsin (amylase), steapsin 
(lipase), rennin (rennase), invertin (invertase), with inorganic salts. Re- 
action: Alkaline. 



SALIVA 



Give the composition of saliva. 

Inorganic 



Organic 



of 



Chlorids 
Carbonates 
Sulfates 
Nitrites 

_ Sulfocyanid of potassium 
Albumin 
Mucin 

Ptyalin (ptyalase) 
Epithelial cells 



Sodium 
Potassium 
Calcium 
Magnesium 



How would you detect the presence of a sulfocyanid in the 
saliva? 

By the addition of a few drops of ferric chlorid to the saliva a red color 
is produced. 

How may mucin be detected in the saliva? 

By the addition of acetic acid a white precipitate, or only a cloudiness 
is produced, insoluble in an excess of the acid. 

How may mercury be detected in the saliva? 

1. By boiling the saliva, slightly acidulated with hydrochloric acid, 
with a clean strip of metallic copper the mercury is deposited on the 
copper and when gently rubbed yields a mirror-like brilliancy; or, if the 
copper strip be dried and gently heated in a constricted glass tube, open 
at both ends, the mercury volatilizes and is deposited in the cooler part 
of the tube as black globules. 



84 



PHYSICS AND CHEMISTRY 



2. Potassium iodid added to the saliva would produce a red precipitate 
of mercuric iodid. 

(a) What organs secrete ptyalin? (b) What action has it 
upon starches? (c) How is it influenced by acids? 

(a) Parotid and submaxillary glands. 

(b) It changes starches into sugar (maltose). 

(c) Acids destroy its activity. 

Describe ptyalin. 

Ptyalin (salivary diastase) is the amylolytic enzyme of the saliva. It 
has never been isolated, and is therefore known only by its action upon 
starch. 



Name the various products of salivary (ptyalytic) digestion 
of starches. 

Starch 

Soluble starch 

I 

Erythrodextrin + Isomaltose 

Achroodextrin (alpha, beta, gamma) + Isomaltose 
Maltodextrin + Isomaltose 

I I 

Maltose Maltose 

In each of these stages beginning with erythrodextrin there is some 
isomaltose produced. 

What is the normal reaction of saliva and to what is it due? 

Slightly alkaline, due to sodium carbonate. 

What salts form the tartar deposited on the teeth? What 
causes its formation? 

Calcium phosphate and carbonate with mucus. 

Cause: Alkaline reaction of the saliva derived from the ammonia in 
the breath and that produced by putrefation of nitrogenous foods held 
between the teeth. The ammonia acts upon the soluble calcium phos- 
phate in the saliva and precipitates it as basic calcium phosphate, 
Ca 3 (P0 4 ) 2 . 

GASTRIC JUICE 

Give the chemical composition of the gastric juice. 

Water, 94-4 per cent. f Sodium 

( Chlorids 1 r I Potassium 

Inorganic ^ Phos P hate J | Calcium 

inor amc v Phosphate of j^ [ Magnesium 

[ Hydrochloric acid 



Solids, 5.6 per cent. 



(Pepsin 
Rennin 
Lipase 



1 1 

What is the PMCtlOII Ol normal gastric |tllC€, ami to \shat is 
it due? 

.', due to free hydro* in. per ( ent 



QiVC the composition ot blood. 



about 91 p 



sjitU, kboul 9 1 • 



I 

While COipU 

Hl<xxi plaquet I plateli 

{( larb" 
Phogpl .xliurn 

ChJorid 

' Scrum albumin 

Proteini ■ Scrum globulin 
Flbrinogi 

1 



What is hemoglobin? Name some of its properties and its 
functions. 

Hemoglobin is the red coloring matter of the blood and is a compound 

proteiil composed oi an albuminous radicle (globin) and an iron-contain- 
ing pigment (hemochromogen), which very readily combines with o 
to form hematin. Hemoglobin is a solid body of a red color, very soluble 
in water, especially when alkaline. Its function is to carry oxygen. It 
forms with oxygen a very unstable compound called oxyhemoglobin, which 
readily gives up its oxygen to the various tissues of the body. 

What are the constituent elements of hemoglobin, and how 
does it differ from oxyhemoglobin? 

C, II, N, O, S, Fe. Oxyhemoglobin contains two atoms of oxygen 
loosely combined with the molecule of hemoglobin. 

What is the coloring matter of the blood, and what metallic 
element does it contain? 

The coloring matter of blood is hemochromogen, present in the 
molecule of hemoglobin, and contains the metal iron. 

BONE AND MUSCLE 

What are the chemical components of bone? 

Organic matter, commonly called ossein, phosphates of calcium and 
magnesium, carbonate, chlorid and lluorid of calcium, and iron. 



What inorganic salts enter into the formation of human 
bone? Which is most important? 

Calcium phosphate 85.7 per cent. 

Magnesium phosphate 1.5 per cent. 

Calcium carbonate 1 1.0 per cent. 

Calcium chlorid and fluorid r.o per cent. 

Ferric oxid 0.8 per cent. 

Calcium phosphate is the most important constituent. 



86 PHYSICS AND CHEMISTRY 

Mention the principal constituents of muscle. 

Water, 76 per cent. 

Solid, 24 per cent., consisting of: 

Proteins 17.6 per cent. 

Collagen 3.0 per cent. 

Fat 1.5 per cent. 

Creatin 0.2 per cent. 

Nitrogen-free extractives 0.4 per cent. 

' Na * 



c u / Chlorids 1 . 
Salts \ Phosphates } of 



K 

Ca 

Fe 



1.3 per cent. 



What chemical changes take place as a result of muscular 
activity? 

The tissues are oxidized into C0 2 , urea, creatinin, uric acid, and the 
various purin compounds, and again rapidly repaired by formative 
material carried by the circulation. 

Give the chemical constituents of (a) dentine, (b) enamel. 
State the properties of each constituent mentioned. 

(a) Constituents of Dentine: 

Woman Man 

Organic matter — ossein and vessels 27 .61 20 .42 

Calcium phosphate 66 . 72 67 . 54 

Calcium carbonate 3 .36 7 .97 

Magnesium phosphate 1 . 08 2 . 49 

Soluble salts, chiefly sodium chlorid o .83 1 .00 

Fat 40 .58 

(b) The average composition of enamel is: 

Water and organic matter 3.6 

Calcium phosphate and traces of fluorid 86 . 9 

Magnesium phosphate 1.5 

Calcium carbonate 8.0 

The inorganic salts give form and strength to the organ while the 
organic material is used up in the stroma and the nutritive vessels and 
nerves. 



Give the composition of human and cow's milk. 

Human Cow 

Water 87 .41 per cent. 87 . 17 per cent. 

Solids 12 . 59 per cent. 12 .8^ per cent. 

{Caseinogen 103] 3-° 2 l 

Lactalbumin \ , > 2.29 per cent. J- 3 .55 per cent. 

Lactoglobulin / ' 2 J o . 53 J 

Fat (butter) 3 . 78 per cent. 3 .69 per cent. 

Sugar (lactose) 6.21 per cent. 4.88 per cent. 

Ash 0.31 per cent. 0.71 per cent. 

In what respect does human milk differ from cow's milk? 

Human milk contains more sugar, fat, and water, and less proteid 
and ash than cows' milk. 






Ml I A I I I 



METALLURGY 

w hat is metallurgy? 

it is tin- science <>r art of separating metals form their on 
simple combinations with nonmetallic elements, and theii application to 

useful purposes. 

What is a metal? 

A metal Is to elementary substance, usually solid at ordinary temper- 
atures, insoluble in water, fusible by heat, and possessing luster. I » 
these qualities must be added those of conducting heat and electricity, 
which metals possess to tin- greatest extent, tin- power of replai ing hydro- 
gen in chemical actions, and of forming basic oxids with oxygen. 

Differentiate metallic element, metallic compound, and 
amalgam. 

A metallic element is a substance, all the atoms of which are alike and 
which exhibits the characteristics of metals. 

A metallic compound is a metal in combination with another substance, 
metallic or nonmetallic. 

An amalgam is a combination of one or more metals with mercury. 

Mention the two groups into which metals are divided. 

Noble and base metals. 

What constitutes the difference between a noble and a base 
metal? Give examples of each. 

Noble metals are those which are capable of being separated from 
combinations with oxygen by merely heating to redness. The base 
metals are those whose compounds with oxygen are not decomposable by 
heat alone. 

Noble metals: Gold, silver, platinum, mercury, palladium, irid- 
ium, etc. 

Base metals: Lead, cadmium, bismuth, sodium, zinc, etc. 

Write the names of ten metals used in dentistry and state the 
proportion that this number of metals bears to the entire num- 
ber of known metals. 

Gold, silver, zinc, lead, tin, platinum, copper, mercury, iron, aluminum; 
these represent about one-sixth of the total number of metals, which is 
about sixty-one. 

Mention three heavy metals. Give the symbol and atomic 
weight of each. 

Lead = Pb. 205.4 
Mercury = Hg. 198.9 
Gold = Au. 169.6 



88 PHYSICS AND CHEMISTRY 

Give the atomic weight of three light metals with their sym= 
bols. 

Potassium, K, 38.85; Sodium, Na., 22.87; Aluminum, Al., 26.9. 

Place the chemical symbol after each of the following ele- 
ments: Lead, tin, aluminum, antimony, nickel. 

Lead, Pb; Tin, Sn.; Aluminum, Al; Antimony, Sb; Nickel, Ni. 

Define tenacity. 

Tenacity is the resistance shown by a substance to dissolution or 
fracture through the medium of stretching or pulling force. 

What is meant by tensile strength of a metal? How is it 
designated and by what means is it determined? 

Tenacity of a metal or tensile strength refers to the resistance the 
metal shows to a pulling or stretching force. Iron, for instance, in the 
form of wire one-tenth of an inch in diameter will sustain 705 pounds 
and copper 385 pounds. It may be determined by means of the Riehl 
testing machine, which is similar to a lever scale. By means of a ratchet, 
tension is made on the specimen and the number of pounds registered on 
the lever bar. 

How is tensile strength of metals affected by drawing them 
into wire? (c) State why. 

It is increased, (b) owing to the compression, and consequent greater 
cohesion of the molecules, caused by drawing the metal through the draw 
plate. 

Define separately the terms: Ductility, malleability, and 
volatility, and give examples of each. 

Ductility is that property of certain substances by virtue of which 
they may be drawn into wire. Examples: Gold, copper, platinum. 

Malleability is that property of certain substances by virtue of which 
they may be beaten or rolled into plates or sheets. Examples: Gold, 
lead, tin. 

Volatility is the power of certain substances to pass from the solid or 
liquid state to the gaseous. Examples: Iodine, ether, kerosene. 

Name some of the more malleable metals. 

Gold, tin, copper, silver, platinum. 

Name five metals all of which can be manufactured into 
wire, sheet or foil. 

Gold, silver, platinum, copper, aluminum. 

Which metal is (a) the least tenacious, (b) the most infusible, 



t the bed for electromagnets, d the beef for electrocoo- 

dllCtOrS, (e) the most rare? 

(a) MerCUry; t.) uMiiiun (e) radium. 

what metal Ii the beel conductor of beat? Of electricity? 
Silver is the best conductor of both beat tnd electricity. 

Went ion some metals having (a | very low fusing-point s ; 
(b) ver\ high fusing-points. 

(.ii Mercury,— 35 ■. | C; rubidium, : (8.5 ( ' .; pott -ium, <<: I '. 

(b) Platinum about 1775 C; Pure iron about [000/ C.;gold iooi°C. 

Describe five metals and give the fusing-point of each. 

Gold (fusing-point 1001.7 C), a soft, malleable, ductile metal of a 
yellow color. When thin it transmits a greenish light, does not oxidi/e 
in air, and is cohesive to tin- point of welding cold. 

Copper (fusing-point 1080.5 C), slightly harder than gold and slightly 
less malleable and ductile. Of B reddish color, is a good conductor of 
heat and electricity and enters into the composition of such valuable 
compounds as brass, bronze, and German silver. 

Tin (fusing-point 232 C), soft, malleable, silver}' white metal which 
volatilizes when heated, is cohesive when pure, and is used to form 
solders and alloys. 

Zinc (fusing-point 410 C), a crystalline, brittle metal of a silvery white 
color. When heated it is malleable and ductile. It is used for dies and, 
with copper, forms brass. Its oxids are used as the powder in dental 
cements. 

Lead (fusing-point 326 C), soft, malleable and ductile metal of a 
bluish-gray color. It volatilizes when heated and is used in forming 
solders and for counter-dies. 

Compare gold, silver, copper and tin as to conductivity of 
heat. 

Silver, 100; copper, 73.6; gold, 53.2; tin, 14.5. 

Name three metals which are excellent conductors of elec- 
tricity, heat and cold. Are these properties desirable or objec- 
tionable in metal base dentures? Give reasons. 

Silver, gold, copper. 

Such properties are desirable. One of the principal causes of irri- 
tation of the mucous membrane under artificial dentures is caused by the 
lack of conductivity of such bases as rubber. Metals conduct the heat 
away and preserve the normal temperature of the mucous membrane. 

Give atomic weight and symbol of gold, silver. 

Gold, Au; atomic weight, 196.6. Silver, Ag; atomic weight, 108. 

Mention the only three metals which are attracted to the 
magnet and which can themselves become magnets. 

Iron or steel, nickel, cobalt. 



9 o 



PHYSICS AND CHEMISTRY 



What is the difference between an assay and analysis? 

An assay is a process for determining the proportion of certain sub- 
stances in a compound, such as the amount of gold and silver in a piece 
of ore. 

An analysis is the process of determining the relative amounts by 
weight of all substances in a given compound. 

State two processes of joining metals. 

Fusing or welding, and soldering. 

What conditions are essential for the perfect welding of 
metals, whether hot or cold? 

Absolute cleanliness of surfaces to be welded and sufficient heat or 
pressure. 

Describe the difference between welding and soldering metals. 
(b) Is a new alloy formed of the metal and solder at the lines 
of union? 

Like metals are welded by bringing the absolutely clean surfaces 
together under great pressure or by the fusing of the surfaces in contact. 
In soldering, the separate pieces of metal (like or unlike) are joined by 
melting and flowing a fusible metal between the surfaces to be united, 
(b) There is. 

Why is a flux used in soldering metals? Name two sub= 
stances so employed. 

A flux is used to cleanse and purify the surfaces to be soldered by 
removing oxids and foreign substances, thereby facilitating the flow of the 
solder. Borax and zinc chlorid may be used. 

In uniting platinum to platinum, what would you use as a 
solder, and why? 

Pure gold, because it fuses below the fusing-point of platinum and 
unites very strongly with it. Gold solders do not unite so well with 
platinum and consequentiy the union is less secure. 



Explain the difference between annealing and tempering 
metals, and give an example of each process. 

Annealing is the process of softening a metal, restoring to the fullest 
extent its qualities of ductility and malleability which may have been 
lost through hammering or sudden chilling. Example: Gold which 
has been hammered becomes hard and springy. Heating it to redness 
separates the molecules, and upon slowly cooling the metal assumes its 
natural qualities of malleability and ductility. 

Tempering is the process of rendering a metal hard and brittle or 
lessening its quality of malleability or ductility. Example: Surgical 
or dental cutting instruments are ground into shape while the steel is soft. 
The steel is then heated at a little distance from the point till the point 
shows a straw color, when the instrument is plunged in oil. 



Ml I \l I I <)l 

State the requisite properties of metals u^i\ for dies. 
Lou fusibility, aoncontractilit} on hardening, hardness and < 

■ 

What metals aiul allo\s are used tor dies and COUlltW dJCHT 
State tor which each li best adapted. 

I ties: Zinc, Babbits metal (copper antimony and tin), Eiaskell'i • 
(copper antimony and ball tin- amount of tin in Babbits metal), tin and 

antimony, lead, tin. bismuth, antimony and iron. 

Counter dies: \a-aA, type metal, lead and tin. 

How does alloying affect the ductility of the noble metaK? 
The ductility of an alloy is less than the ductility of any of the con- 
stituent metals. This is most marked in alloying a noble with a base 

nu-tal. 

What special properties of metals are most affected by 
alloying? 

Ductility and malleability are decreased, hardness and tenacity are 
usually increased, and fusibility lowered. 

State why an alloy becomes brittle when heated. 

Heating an alloy produces oxidation of the metals. The oxids are 
dissolved in the alloy and lessen the cohesion of the particles. 

In making dental alloy, state the order of fusing the metals 
so that volatilization of the base metal may be prevented. 

Melt the metals in the order of their fusing-points, beginning with 
the highest fusing and protecting the surface with fused borax or charcoal. 

What are the advantages of annealing alloys for dental 
amalgam? Describe the process. 

To overcome the hardness and brittleness caused by cutting or filing 
the alloy. It causes the alloy to unite with the mercury and work up 
smoother in the mortar. 

The alloy is heated and allowed to cool slowly, sometimes the heating 
being done in boiling water. 

Give the approximate composition of brass and German 
silver. 

Brass is an alloy of copper and zinc in the proportion of about 65 parts 
copper to 35 parts zinc. 

German silver is copper 46 parts, nickel 34 parts, zinc 20 parts. 

Describe in detail the process of electro-plating with silver. 

The metal to be plated is first cleaned in a hot solution of caustic 
potash. It is then immersed in a solution of mercuric nitrate, rinsed in 
water, and suspended by a thin wire in the plating solution of silver cyanid 
and potassium cyanid. The wire is connected with the negative pole of 
a battery. A strip of silver is suspended in the solution by a wire which is 
connected with the positive pole of the battery. The current is now 



92 PHYSICS AND CHEMISTRY 

turned on and silver from the solution is deposited on the metal suspended 
by the negative wire. The dissolving of the silver strip on the positive 
pole maintains the strength of the silver cyanid solution. 

Describe (a) negative metallic fillings, (b) positive metallic 
fillings. 

Negative fillings would be formed from metals of weak electro-positive 
nature, such as gold, silver, platinum, etc., and positive fillings from metals 
of strong electro-positive nature, such as zinc, tin, aluminum, etc. 

State the conditions that generate galvanic currents between 
gold and amalgam fillings, and the conditions under which such 
currents may be avoided. In case of galvanic currents, which 
metal, gold or amalgam, will most affect the pulp? 

If a gold and an amalgam filling be placed so as to touch or be nearly 
in contact, the two metals of different electrical potential will generate 
galvanic currents in an acid saliva. This condition may be avoided by 
not placing these metals in contiguous cavities or by keeping the saliva 
alkaline or neutral. These currents will affect the pulp under the gold 
filling the most. 

What are the chemical and physical properties of asbestos? 

It is a fibrous silicate of magnesium and calcium, also known as 
ameanthus. The fibers are parallel, from one to sixty or seventy inches 
in length, and of a silky appearance. It is a very poor conductor of heat 
and is practically unaffected by the flame. It is used as an insulator for 
heat pipes, for filter papers, and to protect combustible or inflammable 
objects from the radiation of heat. 

What does the term "carat" signify? 

"Carat" refers to the proportion of pure gold in an alloy of twenty- 
four parts. Pure gold is 24 carat, while 22 carat gold is 22 parts gold and 
2 of alloy. 

How do you find the carat? 

By means of the following formula: As the weight of the mass is 
to the weight of the contained gold, so is 24 to the carat sought. 

How do you reduce from higher to lower carat? 

Add sufficient silver or copper or both according to the following 
formula: "As the required carat is to the carat used, so is the weight 
used to the weight of the alloyed mass when reduced. Then the weight of 
the mass used subtracted from this will give the quantity of alloy to be 
added." Example: Reduce 4 oz. of 20 carat to 16 carat. 16 : 2o::4 0z. 
: x = 5 oz. — 4 oz. = 1 oz. alloy to be added. 

How do you raise gold from lower to higher carat? 

By adding pure gold according to the following formula: "As the 
alloy in the required carat is to the alloy in the given carat, so is the 
weight of the alloyed gold to the weight of the reduced alloy required. 
Then the weight of the alloyed gold used, subtracted from this gives the 



\tl I \ 

amount of purr i^old to he added." I \.imple: I * . i i 6 OtM ' ; 
carat gold to iS carat. Subtract 10 and l8 from -• ; to find alloy in ( 
carat, then: 

• 1 r t \ 11 \ dwt ; then i i | 1 1 s I . t dwt i \ < 
|old to be added. 

Describe the process of alloying pure gold lO make it suitable 
for 30 carat base plate. (J>) State tbe proportion of each in 
gradient metal. 

Hi-.u ■ crucible and place the metals In it, covered with powdered 

charcoal, ami COVCI crucible with lid. Heat to bright tedneM and stir 

with an iron rod also heated to redness. Pour, immediately after fusion 

takes place, into greased moulds, after which hammer and roll into sheet.-,. 

(b) Pure gold, 20 dwt.; copper, 2 dwt.; silver, 2 dwt. 

gold 6 
What carat would silver 2 be? 
copper 1 

9 :6 :: 24: x, x = 16. 

Give a short description of gold and its dental uses. 

Gold (fusing-point io(>i.7°C.) isasoft, malleable, ductile metal of a 
yellow color. It is obtained pure and in combination with silver, platinum, 
and other metals in the form of ore. It has the quality of welding cold, 
with but little pressure, when pure. Its specific gravity is 19.4; it does 
not tarnish, and is not dissolved by any single acid. It may be dissolved 
with aqua regia. 

In dentistry it is used pure in the form of foil or crystals for filling 
cavities in teeth, and alloyed with silver, copper or platinum in the form 
of plate for the bases of artificial dentures, crowns, bridges, clasps, etc. 
It is used pure as a solder to unite platinum. 

Give two methods for refining gold. 

The chlorin method consists in converting the silver into chlorid by 
the passage of a stream of chlorin gas through the molten alloy. By 
means of a clay pipe passing through the cover to the bottom of the crucible, 
and connected with the chlorin generator by means of a flexible tube, 
the gas is passed rapidly through the melted metal, and is apparently 
absorbed by it. The refining is considered complete when orange- 
colored fumes begin to rise; the crucible must then be removed from the 
fire to prevent the gold itself from combining with the chlorin. 

The wet method consists in adding three parts silver to one part of 
gold in crucible. Fuse, cool, granulate and digest in hot sulfuric acid. 
The silver is digested and the gold left pure, when it may be fused and 



Why do we find the quality of cohesiveness more marked 
in gold than in silver, copper and lead? 

Because of the closeness of its crystalline texture and the fact that 
the surface does not oxidize in the air. 



94 PHYSICS AND CHEMISTRY 

By what process are the various forms of crystal or sponge 
gold produced? 

By the process of precipitation of gold chlorid electrolytically or 
by a reducing agent. 

What metals are used to alloy gold for clasps and springs? 

Platinum, iridium, silver and copper. 

Give the carat and the alloy of the present United States 
Gold coin ; the fineness and the alloy of sterling silver. 

Gold coin, 900 fine or 21.6 carats, alloyed with silver and copper 
Sterling silver, 925 fine alloyed with copper. 

State the effect of tin on an alloy of gold. 

Alloys of tin and gold are hard and brittle, and the combination is 
attended with contraction. The addition of tin diminishes the con- 
ductivity and lowers the fusing-point of gold. 

Name several metals which readily impair or destroy the 
malleability and ductility of gold. 

Antimony, tin, lead. 

Describe a method of (a) refining gold sweepings and filings, 
(b) separating gold and platinum. 

(a) Stir the sweepings with a strong magnet to remove any iron or 
steel that may be present, then place in a graphite crucible with a quantity 
of borax and niter, and melt. Melt in silver to the amount of 3 to 1 with 
the gold. Cool the alloy and pulverize it. Then boil in strong sulphuric 
acid. The gold will be found as a brown precipitate, which may be 
washed, melted, and run into ingots or molds. 

(b) Dissolve the alloy in aqua regia and heat to evaporate the acid. 
Add ammonium chlorid, alcohol and distilled water. Platinic-ammonic 
chlorid will be precipitated. Filter to remove the precipitate and add 
ferrous sulphate to the filtrate. The gold will be precipitated in a brown 
mass, which wash with diluted hydrochloric acid, melt, and run into 
ingots or molds. 

Describe platinum, (b) How is it found in nature? (c) 
Name some of its uses in the arts, (d) What are its special 
dental uses? 

Platinum is somewhat whiter than iron. It is exceedingly infusible, 
requiring the flame of an oxygen blow pipe to render it fluid. The melting- 
point is about 2000 C. It is exceedingly malleable and ductile and is 
exceeded in tenacity only by iron and copper. Specific gravity, 21.5. 
No single acid attacks it and it is unaffected by air or moisture at any 
temperature. 

(b) It is found in nature in flattened grains of varying size, more or 
less alloyed with iridium, palladium, rhodium, etc., in the mountains of 
Brazil, Peru, Australia and California. 

(c) It is used in the manufacture of many scientific instruments, and 
for chemical vessels on account of its indestructible properties. 

(d) In dentistry it is used to strengthen porcelain work, as pins for 



it 1 Mill 

Artificial crowns rod Artificial tooth, And as a ba^r f«.r continuou 
work; foi making matrices In Inlay work, And f<>r alloying gold to 
gold greater. hardness And eUsd< 

Describe ■ method <>t precipitating platinum from its solution. 
State color ami physical condition of the precipitate* 

To .1 Solution of platinic dioxid in dilute sulturit at id add I 

of Ammonia; a black precipitate oi metallic platinum will be formed It 

is a line, black powder known At "platinum Mai k " or fulminating 
platinum. 

Describe two processes of fusing platinum. 

It may he fused between the terminals of an elei trie arc, in the eta trie 
furnace, or with the oxvhvdrogen flame in a concavity of a:. 
block. 

What properties does platinum impart to its alloy with fold? 
Greater strength and hardness, lighter color and higher hising-point 

than gold alone, hut lower than platinum alone. The ductility and 
malleability is greater than platinum and less than gold. 

State the constituent metals and mention use of platinum 
solder. 

Platinum and gold with, sometimes, copper added. It is used to 
solder platinum to platinum. 

Describe iridium, (a) With what other metal is it com- 
bined for dental use? (b) What are the advantages of these 
combinations? 

It is a hard, brittle metal of a grayish-white color, specific gravity 
22.4, fusible only by the oxyhydrogen blow pipe. It becomes somewhat 
malleable at red heat. It is not acted on by aqua regia. 

(a) and (b). In dentistry it is used alloyed with platinum to impart 
greater strength and rigidity to the platinum. 

Give in regard to iridium (a) its symbol, (b) its physical 
properties, (c) its sources, (d) its specific use in dentistry. 

The symbol for iridium is Ir. Atomic weight, 192.5. It is a silvery 
white metal, very dense, and resembling platinum in its physical char- 
acteristics. It is found in ores containing also platinum, palladium 
osmium, etc., chiefly in the Ural mountains. It is used in dentistry 
alloyed with platinum to give the latter hardness and more elasticity. 

Give the physical properties of silver, and state its most 
important salt. Define the use in dentistry. 

Brilliant whiteness, ductility and malleability, almost equal to gold. 
Slighdy harder than gold, less than copper. Fusing-point 960. 5 C; ■ 
when fusing, it absorbs oxygen to the extent of twenty-two times its own 
volume. Specific gravity 10.42 to 10.53. It is the best conductor of 
heat and electricity known. It tarnishes in air containing hydrogen 
sulnd. 



96 PHYSICS AND CHEMISTRY 

The most important salt is silver nitrate, AgN0 3 . Silver is used in 
dentistry alloyed with other metals to form amalgam, solders, plates, 
etc. Silver nitrate is used as a styptic, cautery and germicide. 

Describe a method of obtaining silver from one of its native 
ores. 

The ore is powdered, mixed with common salt and roasted at a dull 
red heat. Sulfid of silver is converted into chlorid. The mixture, 
which consists of earth matter, metallic oxids, soluble salts, silver 
chlorid and metallic silver, is sifted and placed in barrels arranged to 
revolve on axes. Scraps of iron and water are added, and the whole 
agitated to reduce the chlorid to the metallic state. Mercury is then 
added, which amalgamates with the silver and subsides. The excess 
mercury is squeezed out and the mass heated in a retort to distil off the 
mercury. 

Describe the chemical process for recovering pure silver from 
refuse amalgam. 

Drive off the mercury by heating to a red heat, pulverize the mass and 
dissolve in nitric acid (50 per cent.) ; pour off the liquid into another glass 
and add sodium chlorid. Silver chlorid forms as a precipitate. Add a 
little sulfuric acid and a piece of iron. When the precipitate becomes 
a gray color, filter, and wash precipitate with dilute hydrochloric acid, 
followed by water. Fuse the precipitate in a crucible with potassium 
carbonate and pour into mold. 

Would you use silver in making plates? Why? 

No. Pure silver is too soft and flexible for plates, and even when 
alloyed with other metals, shows such a strong affinity for sulfur that it 
is undesirable for plates. When alloyed with a large percentage of plati- 
num it may be used to advantage. 

Write the formula for silver solder, (b) What property 
does each ingredient impart? 

Silver 66 parts, copper 30 parts, zinc 10 parts. 

Silver gives the desired color. 

Copper gives strength and tenacity. 

Zinc lowers the fusing-point and gives hardness. 

How would you distinguish a bar or plate of tin from a metal 
of similar appearance? 

By the "tin cry," a peculiar creaking noise produced by bending tin. 

Mention the principal ore of tin and describe the process of 
extracting metallic tin from the ore mentioned. 

Tin is found chiefly as the dioxid Sn0 2 mixed with other minerals, 
such as arsenopyrite, molybdenite and wolframite. This natural oxid 
is seldom pure. In order to obtain pure tin, the ore must be thoroughly 
calcined, then extracted with concentrated hydrochloric acid, and washed 
with water. If this purified material be now mixed with charcoal and a 
suitable flux, and brought to a bright red heat in a proper furnace, the 



\n [ALL! 

•i will be removed by me carbon, tnd pure metallic tin and a 
tlag result 

Describe the general properties of aluminum, b ll«»w is 
it employed in dentistry? c win is its use- limited? 
It las white, silvery metal, very malleable and ductile i 

hU* to a nigh polish, is highly sonorous, and is only tw<> and a half l 
heavier man water. Specific gravity is 1.56 and fu Ing-point I 

(\>) it is used aa ■ base for artificial dentures, eith< 
It is also used for handles of dental instruments, imprea ion I 

h^ use is limil ! because it is quite soluble in alkaline -<>lu: 
contra idy on cooling, and is soldered only with great difficulty. 

Mow is aluminum obtained? Qlve Symbol and atomic 

weight. 

By electrolysis oi aluminum ore, or by heating in a reverberating fur- 
nace ten parts of double chlorid of aluminum and sodium, five part- of 

double fluorid of aluminum and sodium, and two parts of metallic 
sodium. Symbol, Al. Atomic weight, 

Why cannot amalgam of aluminum and mercury be em- 
ployed to till cavities in teeth? 

• aluminum generates considerable heat and expands greatly 
ftting as an amalgam. It also oxidises readily in the mouth. 

Give the properties of metallic zinc and state its uses in den= 
tistry. 

Zinc is a hard, brittle, bluish white metal of a crystalline nature. Sped- 
ivity, 6.9. Fusing-point, 419 C. At 940 C. it boils and volatilizes. 
When heated to ioo° C. to 150 C. zinc becomes quite malleable and may 
be rolled into sheets. At 205 zinc becomes so brittle that it may 
be powdered in a mortar. It does not oxidize in air at ordinary tem- 
perature, but when strongly heated burns with brilliant incandescence. 
It is used in dentistry to form metal dies and counter-dies. In con- 
junction with other metal it forms solders and amalgams. Its oxids, 
chlorids, and sulfates are used in manufacturing dental cements. Zinc 
chlorid is an obtundent and disinfectant. 

Mention two important ores of zinc, and describe the process 
by which the metal is obtained from one of the ores. 

Sulfid of zinc (zinc blend) and the hydrous silicate (calamine). 
The calamine is roasted to expel water, then mixed with fragments of 
coke or charcoal and distilled at a full red heat in an earthen retort. Car- 
bon monoxid escapes, while the reduced metal volatilizes and is con- 
densed by suitable means. 

Write the equation showing the action of (a) hydrochloric 
and (b) sulphuric acid on zinc. 

Zn 2 + 4HCI = 2 ZnCl 2 4- 2H 2 
Zn" 2 + 2 H 2 S0 4 = 2 ZnS0 4 4- 2H 2 

7 



98 PHYSICS AND CHEMISTRY 

Distinguish chemically between oxychlorid and oxyphos= 
phate of zinc. State the conditions indicating the use of each 
in dentistry. 

The powder in each cement is nearly the same, the oxyphosphate con- 
taining more oxid of zinc. The liquid of oxychlorid consists of zinc 
chlorid, diluted with water, and the liquid of the oxyphosphate of glacial 
phosphoric acid, dissolved in water and then evaporated to the consistency 
of glycerin. 

The oxychlorid sets slower, shrinks on setting and show r s antiseptic 
qualities. It is used for root canal fillings, capping pulps and lining 
cavities, whitening teeth and temporary fillings. 

Oxyphosphate is used as a semi-permanent filling and for setting 
crowns, bridges and inlays. 

Give a formula for common brass wire and the dental uses 
of same. 

Copper 64 parts, zinc 36 parts. It is used in orthodontic work to 
ligate the teeth to the retaining arch, to jack and traction screws, and to 
ligate the teeth one to another in pyorrhea alveolaris and fracture cases. 

Mention the properties and give the composition of cast iron. 

Cast iron is more fusible and brittle than the other forms of iron, is 
grayish in color and crystalline in character. It contains 1.5 to 4.5 per 
cent, of carbon. When rapidly cooled, all the carbon is retained, producing 
" white cast iron," which is very hard and brittle. When cooled slowly, a 
portion of carbon separates, forming small specks of graphite, making 
"gray cast iron." Cast iron also contains manganese, silicon, phosphorus 
and sulfur. 

Mention the important ore of mercury and describe the pro= 
cess of obtaining it. 

Cinnabar, HgS, or mercuric sulfid. The cinnabar is heated in a 
retort and the vapor condensed in another chamber surrounded by cold 
water. The mercury is then washed with dilute hydrochloric acid to 
digest impurities. 

State some of the general uses of mercury. 

Thermometers, barometers, etc., to form amalgams with metals for 
filling teeth, to amalgamate zinc for electric batteries, and in conjunction 
with silver or tin to back glass in making mirrors. It is used in several 
forms, such as mercuric ointment, iodid of mercury, etc., in medicine. 

Name some of the metals for which mercury possesses great 
affinity. 

Gold, silver, tin, zinc, lead, bismuth, cadmium, potassium. 

How are the impurities of mercury detected and how readily 
removed. 

A drop or globule of pure mercury should be round and the surface 
bright, with no oxidation. If it is dull or leaves a trail when allowed to 
roll over white paper, it is impure. It may be purified by distillation or 
by a bath of nitric acid. 






99 

What important properties ihoilld amalgam \<>r tilling teeth 
possess? 

Hardness 01 density to resist attrition, and 
strength, it should be unaffei ted t>\ the <>r.il Quids, .nxi !><•<• from metals 
forming poisonous salts, it should have pennant >nn and n 

it- | oloi and polish. 

State the CODditk>HS under which amalgam WOOld be im- 

proved b) washing. 

When the mass has become contaminated frith oil o From the 

hands, washing in alcohol, ether or chloroform is advisable. 

Write the formula tor a standard three metal alloy for amal- 
gam fillings. 

Flagg's contour alloy: Tin 37, sflver 58, gold 5. 

Describe the chemical process involved in the setting <>f 

amalgam. 

When mercury is added to an alloy a chemical action takes place and a 
solid chemical compound is formed. This is proven by the evolution of 
heat and the crystalline nature of the mass after amalgamation has 
:i place. 

Describe the properties of copper amalgam. Name some 
of its advantages and disadvantages. 

Pure copper amalgam is prepared by precipitating copper from a 
solution of cupric sulphate, with mercury at the bottom of the vessel, and 
stirring with a clean iron rod. The precipitate of copper collects on the 
rod, is removed, washed with cold water, ground in a mortar while wet 
with hot water, acidulated with sulphuric acid. The mass is now washed 
in ammonia, then water, triturated till amalgamation takes place and 
formed into small pieces of convenient size. When needed for filling, a 
piece is heated on an iron spoon till mercury appears on the surface, when 
the pellet is ground in a mortar and manipulated as an ordinary amalgam. 
It makes a very hard, dense filling, with fine margins, and is said topre-er\ e 
tooth structure; but it turns an intense black and in some mouths disin- 
tegrates and stains the tooth structure. 



ANATOMY 



Give a brief yet comprehensive description of the heart. 

The heart is a muscular structure surrounded by the pericardium. It 
consists of four cavities — two auricles and two ventricles. The auricles 
receive the blood from the large veins and transmit it to the ventricles. 
Their walls are thin in comparison with those of the ventricles. The 
right auricle receives the blood from the superior and inferior venae cavae; 
its inner surface is smooth, except in the auricular appendix, a small cavity 
arising from the upper inner surface of the auricle, which contains numer- 
ous rugae called musculi pectinati. On the inner surface of the right 
auricle one finds the annulus ovalis, which in fetal life is a foramen com- 
municating with the left auricle. The Eustachian valve is a fold of the 
lining situated below the opening of the inferior vena cava. Below the 
Eustachian valve the opening of the coronary sinus is situated. The right 
auricle communicates with the right ventricle by means of the tricuspid 
orifice, which is closed by the tricuspid valve. The left auricle resembles 
the right in that it is smooth and has an auricular appendix. The four 
pulmonary veins empty into it, and it communicates with the left ventricle 
by means of the mitral orifice, which is closed by the mitral valve. 

The right ventricle is the largest of the four cavities; its walls are irregu- 
lar and marked by rugae, which are called columnce carnece. The tricuspid 
valve has three leaflets, each leaflet being connected to the ventricular wall 
by a papillary muscle ; the attachment between the valve and the muscle is 
called a chorda tendinea. The ventricle expels its contents into the pul- 
monary artery, which is guarded by three semilunar folds or valves. 

The left ventricle receives the blood through the mitral valve. The 
cavity resembles the right, except that it is smaller, and the papillary 
muscles are larger and fewer in number, the mitral valve having only two 
leaflets. The columnae carneae are also larger and fewer in number. The 
walls of the left ventricle are thicker than those of the right. The blood is 
pumped into the aorta through the aortic orifice, which is guarded by 
three semilunar valves. 

The coronary arteries arise from the beginning of the aorta and are two 
in number, one for the right, and one for the left side of the heart. The 
veins which drain the heart muscle empty into the coronary sinus of the 
right auricle. The nerve supply is derived from the pneumogastrics and 
from the cardiac plexus of the sympathetic. 

Describe the structure of the arteries and give their nerve 
and blood supply. 

The arteries have three coats: an inner, endothelial layer, the intima y 
strengthened by yellow elastic tissue; an intermediate, circular layer of 
unstriped muscle, the media; and an outer layer, the adventitia, consisting 
of connective tissue with connective-tissue corpuscles. In addition, the 

ioo 



Akii kii s IOI 

arteries are endoted in a oonnecthrc beau r pply is 

effected by small arterie mm irhich are distributed to the 

outer .tn« I middle ooats and arise from the same, 01 bom an adjacent \<- «l 
The blood is returned by small veins. The art* iplied with 

medullated and aonmedullated irhich form plexuses on the 

outer .Miri.u es of the i esse! u 

\\ hat is the circle of Willi*? 

\ i arterial anastomosis at tin- base of the brain, it Is formed m I 
by tin* anterior cerebral arterie-, branches of the internal carotid, irhich 

mnected by the anterior i ommunicating; behind, by tin- posterioi 
brals, branches *>t" the basilar, which are connected on each side with the 

internal carotid by the posterior communicating. 

Describe the external carotid artery. 

Arising opposite the upper border of the thyroid cartilage, it p.: 

upward and forward, and then UK lines backward to the >pai e brt v. ten the 
neck oi the condyle of the inferior maxilla and the external auditory mea- 
tus, where it divides into the superficial temporal and the internal maxil- 
lary. Other branches are superior thyroid, lingual, facial, occipital, 
posterior auricular, and ascending pharyngeal. 

Describe the internal maxillary artery. 

It is one of the terminal branches of the external carotid and runs 
through the zygomatic fossa; it is divided into three portions by the exter- 
nal pterygoid muscle. Its branches are the tympanic, middle and small 
meningeal, and inferior dental; the masseteric, deep temporal, and exter- 
nal and internal pterygoid; alveolar, spheno-palatine, pterygo-palatine, 
descending palatine, and infra-orbital. 

Describe the lingual artery, and give its branches. 

It is the second branch of the external carotid, and runs forward beneath 
the hypoglossus muscle to supply the tongue. Its branches are the hyoid, 
dorsalis lingme, sublingual, and ranine. 

Describe the inferior dental artery. 

It is a branch from the first portion of the internal maxillary artery. It 
passes into the inferior dental canal and supplies all the lower teeth; 
finally leaving the canal at the mental foramen, where it becomes the 
mental artery. 

Describe the subclavian artery. 

On the right side of the neck it arises from the innominate artery; on 
the left side, from the arch of the aorta. It is divided into three portions 
by the scalenus anticus muscle. It passes transversely across the neck 
above the first rib, and, gradually curving downward, crosses the first rib, 
where it becomes the axillary artery. Its brandies are the vertebral 
thyroid axis, internal mammary, and superior intercostal arteries. 

Describe the superior vena cava. 

It returns the blood from the head, neck, upper extremities, thoracic 



102 ANATOMY 

wall, and a portion of the upper part of the posterior wall of the abdomen 
It is formed behind the first right costal cartilage by the union of the two 
innominate veins, and descends, with a slight convexity to the right, to the 
level of the third right costal cartilage, where it opens into the upper and 
back part of the right auricle. The lower half is within the pericardium. 
Its tributaries are the vena azygos major, pericardial, and mediastinal 
veins. 

Describe the inferior vena cava and name the veins that enter 
into its formation. 

It returns the blood to the heart from practically all parts of the body 
below the diaphragm. It is formed by the junction of the two common 
iliac veins, on the right side of the intervertebral disk between the fourth 
and fifth lumbar vertebras. Passing upward on the front of the spine, 
where it lies to the right of the aorta, it traverses the under surface of the 
liver in the fissure of the vena cava, perforates the central tendon of the 
diaphragm, and enters the pericardium, terminating in the lower back 
part of the right auricle. 

Describe the internal jugular vein. 

The vein is formed in the jugular foramen by the junction of the lateral 
and inferior petrosal sinuses. It courses down the neck, beneath the 
anterior border of the sternocleidomastoid muscle accompanied first 
by the internal, and then by the common carotid artery, and throughout 
its course by the pneumogastric nerve. The vein is contained in the same 
sheath with the artery and nerve, but separated from these structures by 
a distinct septum. At first the vein lies behind the internal carotid artery; 
but as it descends it gradually passes to the outer side of the vessel and 
later along the outer side of the common carotid, partially overlapping the 
artery in front, to its termination behind the sternoclavicular articulation, 
where it unites with the subclavian to form the mnominate. 

Give the course and relations of the external jugular vein. 

The vein is formed on the surface of the sternomastoid muscle, below 
the angle of the jaw, by the union of the posterior auricular with the tem- 
poromaxillary vein. It descends to the anterior part of the subclavian 
triangle and there terminates in the subclavian vein, after piercing the 
deep fascia and crossing the third portion of the subclavian artery. 

What blood=vessels pass to and from the liver? 

The hepatic artery and portal vein and, in the fetus, the umbilical 
artery carry blood to the liver; the organ is drained by the hepatic veins. 

Describe the portal system. 

It is a venous system which drains the alimentary tract from the 
esophagus to the rectum; also the spleen and pancreas. It is formed 
by the superior and inferior mesenteric and splenic veins, and empties 
into the liver at the transverse fissure. Ramifying around the lobules, it 
finally empties into the intralobular veins, which form the hepatic vein 
The hepatic vein empties into the inferior vena cava. 



mi in 
Name the constituents of the blond and the number «»i M 

per t ubk centimeter. 

I hi- blood i onsisl - of pla un l, red bite « orp 

platelets and hemoglobin, rhei round, biconca 

5 microns in diameter, 5,000,000 to the cubic centimeter. Hu- white 
corpuscles 01 leukocyte fourvariel ill mononud< 

mononuclear, polymorphonuclear and eosinophiles. All thi 
number 5000 to 10,000 per cubic centimeter. The blood plalok 
indeterminable amount; the hemoglobin is the blood-coloring matt 

Describe the blood platelets. 

They are homogeneous or faintly granular bodies, one-third the 
of red corpuscles, that circulate in the blood. They are round or 

colorless and devoid oi hemoglobin. There are about 300,000 platelets 

in one cubic millimeter oi blood. 

What is the lymphatic system? Describe the thoracic and 
right lymphatic ducts. 

The lymphatic system consists of lymph duets, glands, and tluid 
lymph. The lymph duets drain the lymphatic glands. They extend to 
every portion oi the hotly. The ducts in the lower abdomen and lower 
extremities unite to form the rcccptaculum chyli. This lymph space is 
drained by the thoracic duct which, after receiving the tributaries from the 
left half of the thorax, upper extremity, and head, empties into the left 
subclavian vein. The right lymphatic duct drains the right side of the head 
and right thorax in the upper extremity, and empties into the right 
subclavian vein. 

What are the lymphatic glands? 

They are globular, ovoid, tlattened bodies, consisting of fibrous frame- 
work, lymph sinuses, and lymph follicles. They form part of the general 
lymphatic system. 

Mention and describe the salivary glands. 

Parotid, submaxillary, and sublingual. 

The parotid gland lies upon the side of the face, immediately below and 
in front of the ear, limited above by the zygoma. It empties its secretion 
into the mouth by way of Stcnson's duct, which runs parallel with the 
zygoma and pierces the buccinator muscle and the mucous membrane of 
the cheek opposite the second mobr tooth. 

The submaxillary gland is below the jaw in the submaxillary triangle; 
it is irregular in form and weighs about 2 drams. Wharton's duct is about 
2 inches long. It passes forward and inward and opens by the side of the 
frenum of the tongue. 

The sublingual gland is situated beneath the mucous membrane of the 
floor of the mouth by the side of the frenum, in contact with the inner 
surface of the lower jaw. The ducts of Rivinus, eight to twenty in num- 
ber, open on the tioor of the mouth on each side of the frenum; one larger 
duct opens into Wharton's duct and is called the duct of Bartholin. 

Structure: The salivary glands are compound racemose glands, con- 
sisting of numerous lobules, each one having a single duct, which ter- 



104 ANATOMY 

minates in an alveolus. The glands are of two kinds: one secretes mucin, 
the other serum-albumin. The sublingual gland is an example of the first 
variety, the parotid, of the second; while the submaxillary gland repre- 
sents a combination of both varieties. 

Describe the structure of the submaxillary gland. 

The gland consists of a number of masses, often as large as peas, which 
are surrounded and held together by connective tissue. These are known 
as lobes, and to each a branch of the duct passes. The lobes are in turn 
made up of a number of smaller masses, or lobules, each having a special 
branch of the lobar duct. Finally, the smallest are made up of a terminal 
branch of the duct, with a cluster of alveoli developed upon it. The 
alveoli, the secreting portions of the glands, are composed of a basement 
membrane, formed of flattened cells, on the outer side of which the blood- 
and lymph-vessels lie. The inner surface of this membrane is lined by 
the secreting epithelial cells, which almost completely fill the alveolus, 
leaving only a small lumen, into which the secretion is shed and passes 
into the duct. 

Give the point of opening of the parotid duct, of the sub= 
maxillary duct, and of the sublingual duct. 

The parotid duct opens in the cheek wall opposite the second upper 
molar tooth; the submaxillary duct opens in the mouth at the tip of the 
frenum linguae; the sublingual ducts open on the floor of the mouth by the 
side of the frenum linguae. 

Describe the thyroid gland. 

The thyroid is a ductless gland. When fully developed it consists of 
two lateral lobes, conical in form, situated on the sides of the upper portion 
of the trachea and alae of the thyroid cartilages. The lobes are connected 
by a narrow transverse isthmus. At times a third lobe is found springing 
from the isthmus and extending upward. The thyroid is enveloped by 
a capsule of connective tissue, from the deep surface of which a number of 
processes penetrate into the organ, dividing it into lobes and lobules. 
Each lobule is made up of numerous closed vesicles filled with a viscid, 
semifluid, colloid material. Vessels and lymphatics are very numerous 
throughout the gland. Arterial supply: superior and inferior thyroid 
veins; superior, middle, and inferior thyroid. Nerve supply: from the 
pneumogastric, middle, and inferior cervical ganglion of the sympathetic 
system. 

Locate and describe the lacrimal gland. 

It is lodged in a depression near the outer angle of the orbit, on the in- 
ner surface of the external angular process of the frontal bone, and is about 
the size and shape of an almond. The vessels and nerves enter the gland 
at its posterior border. The anterior palpebral portion is separated from 
the body by a fibrous septum. It is a compound racemose gland consisting 
of small lobules connected by dense areolar tissue. The secretion is 
serous and is poured out on the conjunctiva by seven or eight ducts at 
the upper outer palpebral angle. 






I 105 

ho. ribe the thj mm glnnd* 

The thymus attains it^ maximum development toward the end of the 
lecond year; from this time on it dwindles away until only a compare! 
mil ill portion la left in tin* newborn child it i-^ of a pinkish < olor, and is 
composed <>i Jaw lateral lobes separated main portion 

of the gland i^ placed In tin- superior and anterior mediastinum ;asa rule, it 
extends downward a^ far as tin- fourth costal carl The 

thymus i> composed of a large numl ill polyhedral lobv 

lobule Is composed of 1 duster of lymphoid folh\ lea with 1 small amoimt 
of delicate connective tissue Intervening between them. ( Contained In the 
follicles are the concentric corpuscles oj He all, 1 1 
composed of Battened cells arranged concentrically around a granular 
nucleated cell. The gland is surrounded by a fibrous sheath whit h sends 
prolongations between the different lobules. 

What arc the suprarenal capsules and what are their rela- 
tions to adjacent organs and parts? 

They arc two triangular organs which lie one on cither side of the ver- 
tebra in intimate relation with the Upper end of the Corresponding kidney. 

In structure they consist of a fibrous network supporting glandular tissue; 

the gland substance IS composed of an external cortical layer which is 
firm is consistence, oi a yellow hue, and forming the chief bulk of the organ; 

and an internal medullary layer, very soft and pulpy in consistency and 
dark in color. The left suprarenal rests on the superior and inner surface 
of the left kidney, the anterior surface is in relation with the posterior sur- 
face of the stomach and pancreas, the posterior surface is in relation with 
the left crus of the diaphragm and left kidney. The right suprarenal rests 
by its base upon the anterior and inner aspect of the right kidney: it is 
situated between the posterior surface of the right lobe of the liver and that 
portion of the diaphragm which covers the side of the vertebra; the vena 
cava rests on the inner surface. 

Name three varieties of tonsils, and give the location of each. 

The pliar yngeal tonsil (adenoid), when present, is found on the poste- 
rior wall of the naso-pharynx. The lingual tonsil is situated on the poste- 
rior surface of the tongue. The faucial, or true tonsils are situated between 
the anterior and posterior palatine arches. The blood supply of the true 
tonsils comes from the ascending pharyngeal, and ascending and de» 
ing palatine arteries. 

Describe the dura mater. Mention the processes and sinuses 
of the dura mater. 

The dura mater is a dense fibrous membrane consisting of two layers 
and lined on the inner surface by endothelium. It is divided into cranial 
and spinal portions. The cranial dura is adherent to the inner surface 
of the cranial wall and performs a double office; it forms the inner peri- 
osteum of the skull and also envelops and protects the brain. It is inti- 
mately adherent at the line of the sutures and around the foramen magnum, 
and at the base of the brain and exit of nerves. At definite places the two 
layers separate and form the cranial sinuses. The spinal dura invests the 



106 ANATOMY 

cord from the foramen magnum to the third sacral vertebra and supplies 
a sheath to the spinal nerves where they emerge from the cord. 

The processes are: the falx cerebri, tentorium cerebelli, falx cerebelli, 
and the diaphragma sellae. The cranial sinuses are: the superior and 
inferior longitudinal, straight, circular, and basilar (unpaired) ; and the 
lateral, occipital, cavernous, superior and inferior petrosal, and spheno- 
parietal (paired). 

Describe the arachnoid. 

It is a delicate membrane, lying between the pia and the dura, which 
bridges over the convolutions. It consists of interwoven bundles of 
fibrous and yellow elastic tissue covered with a layer of endothelium. 
The Pacchionian bodies develop from this layer. 

Describe the pia mater. 

The pia is the innermost of the three meninges and forms the immedi- 
ate investment of the brain and cord. It supports the blood-vessels, dips 
down into the sulci, and passes into the ventricular cavity. The mem- 
brane is thicker and denser in the cord. 

Describe the hemispheres and lobes of the brain. 

The cerebral hemispheres are ovoid, convex on their superior and 
lateral surfaces, partially separated from each other by the longitudinal 
fissure, but connected by the corpus callosum. 

Each hemisphere has five lobes and eight fissures. The frontal lobe is 
bounded internally by the longitudinal fissure, below by the Sylvian, and 
posteriorly by the Rolandic fissure. The parietal lobe extends from the 
longitudinal fissure downward to the fissure of Sylvius, and anteropos- 
teriorly, from the fissure of Rolando to the parieto-occipital fissure; the 
occipital lobe lies behind the parieto-occipital fissure; the temporosphe- 
noidal occupies the middle fossa of the skull and is bounded in front by 
the fissure of Sylvius; the central lobe, or island of Reil, lies in the fissure of 
Sylvius, covered by the frontal and temporosphenoidal lobes. 

Name the principal lobes of the brain and the fissures dividing 
them. 

Frontal, parietal, temporosphenoid, occipital, and central (island of 
Reil) . The fissure of Rolando separates the frontal from the parietal ; the 
fissure of Sylvius separates the frontal and parietal from the temporosphe- 
noidal lobe; the parieto-occipital fissure separates the parietal from the 
occipital; and the central lobe lies in the fissure of Sylvius, at the base of 
the brain. 

In the anatomy of the brain what is the corpus callosum? 
Describe its connections? 

It is a thick, arched layer of transverse fibers at the bottom of the longi- 
tudinal fissure ; anteriorly, it curves upon itself and gives off two peduncles 
at the entrance of the Sylvian fissure; posteriorly, it is continuous with the 
fornix. It forms the roof of the lateral ventricles. A median depression 
on its upper surface is called the raphe, parallel to which, on each side, run 
two or more elevated bands, the strice longitudinales (nerves of Lancisi). 



- 

WEST 

VA. 



»id k 



Name and bound the ventricle! ol the brain* 

iwn lateral, third, fourth, rod fifth. 
l be boundaries are: 

/. - .. utricle roof: corpus callosum; floor: corp 
semicircularis, optic thalmus, choroid plexus, corpus fimbriatum, rod 

fornix; internally, the Septum lucidum; externally, llic brain sub 

.staii* a 

/ rich the roof [a formed by the velum Interpositum 

lateral iralls bj the optic thalami and the peduncles of the pineal gland; 
the Boor Ks formed by the posterior perforate spa* <• 'I he ventrit le Is lim 
[ted in f run t by the anterior crura of the fornix and pari of the anterior 
commissure; behind, by the posterior commissure. 

/ mrtk ventricle — the roof is formed by the valve of Vieussens, the 
cerebellum, and the inferior medullary velum; the floor is formed by the 

posterior BUrfaOS of the medulla and pons; laterally, it is hounded by the 
Superior, middle, and inferior pedum les of the cerebellum. 

The fifth ventricle is the space between the two layers of the septum 

lucidum; it is covered by the corpus callosum. 

Describe the medulla oblongata. 

It is the upper, enlarged portion of the spinal cord, extending from the 

upper border of the atlas or decussation of the pyramidal tracts to the 

lower border of the pons. The posterior surface forms the lower half of 
the fourth ventricle; its anterior surface rests on the basilar groove of 
the occipital bone. The medulla is divided into two lateral halves by the 
anterior and posterior median li-sures. From the sides of the medulla 
the ninth, tenth, cranial portion of the eleventh, and twelfth nerve- arise. 
It contains vasomotor, cardiac, respiratory, deglutition, and mastication 
centers. 

The anterior pyramid is formed by the crossed and direct pyramidal 
tracts of the spinal cord; the former decussate at the lower part. To 
the outer side of the pyramid is the olivary body, containing in its interior 
a capsule of gray matter, the corpus dentatum. The outer portion of 
the olivary body is in relation with the lateral tract, which lies in front of 
the restiform body. The latter is the continuation of the direct cerebellar 
tract and passes above into the corresponding hemisphere of the cerebel- 
lum, forming its inferior peduncle. To either side of the posterior fissure 
lies the fasciculus gracilis. The fasciculus gracilis and the fasciculus 
cuneatus represent the continuation of the columns of Goll and 
Burdach. 

Describe the spinal cord. 

The spinal cord is that part of the cerebrospinal axis which occupies the 
upper two-thirds of the spinal canal. It is an elongated, cylindric structure, 
slightly flattened anteroposterior!}-, and partially divided by two fissures, 
a shallow anterior and a deep posterior. It extends from the margin of 
the foramen magnum to the lower border of the first lumbar vertebra and 
terminates in the filum terminale. The cord is about 16 inches in length. 
It presents for examination two enlargements, the cervical and the lumbar. 
The spinal cord gives origin to thirty-one pairs of spinal nerves, each 
having a ventral and dorsal root. 



108 ANATOMY 

Structure: In transverse section the gray matter is arranged in each 
lateral half so as to present a crescentic appearance; the two halves are 
joined by a commissure. The anterior and posterior extremities are 
called horns and give rise to the spinal nerves, anterior motor, posterior 
sensory. In the center of the commissure is the central canal, which is 
continuous above with the fourth ventricle. The white matter surrounds 
the gray and contains the following tracts: anterior pyramidal, between 
anterior fissure and horn; lateral tract, in lateral portion of cord; posterior 
tracts, between the posterior fissure and horn. The canda equina is a 
bundle of nerves running below the cord, but still within the dura, caused 
by the foramen of exit being below the cord. 

State the kinds of nerve fibers. 

Medullated or axon-cylinders covered with the sheath of Schwann, 
and non-medullated or axon-cylinders without the sheath. 

By what tissues are nerve fibers held together? 

In the central nervous system, the nerve fibers are held together by 
neuroglia. The neuroglia is derived from the ectoderm. In the per- 
ipheral nerves, the fibers are held together by connective tissue derived 
from the mesoderm. The tissue surrounding each fiber is called 
epineurium; that holding the fibers into bundles; perineurium. 

Name the twelve pairs of cranial nerves. 

Olfactory, optic, motor oculi, trochlear, trigeminal, abducens, facial, 
auditory, glossopharyngeal, pneumogastric, spinal accessory, and hypo- 
glossal. 

Give the origin and distribution of the olfactory nerve. 

The nerves arise from the under surface of the olfactory bulb; they are 
about twenty in number. They pass through the foramina in the cribri- 
form plate of the ethmoid bone to enter the nose, and are distributed as- 
nerves of smell to the upper third of the nasal septum, the roof of the nose, 
and the superior and middle turbinated bones. 

Describe the origin and distribution of the optic nerve. 

The nerve arises from the optic commissure, pierces the dura, and 
passes from the cranial cavity into the orbit, through the optic foramen. 
In the orbit it is attached to the posterior pole of the eyeball at a point 1/8 
inch on the inner side of the longitudinal axis. The nerve fibers pierce 
the fibrous and vascular coats to connect with the retina. 

Give the function and distribution of the third cranial nerve. 

It is the motor nerve to all the extra-ocular muscles except the external 
rectus and superior oblique: it also supplies the iris and ciliary muscle and 
the motor branch to the ophthalmic ganglion. 

State the origin, function, and distribution of the fourth 
cranial nerve. 

Deep origin from the floor of the aqueduct of Sylvius: superficial origin 



tog 

from Immediately below the inferior <<>t|>«>r.i quadrigemina. It 
to the Miperioi ro le. 

Name the g&IlglUl COIllMCtod with the fifth pair of cranial 

nerves, 

(iasserian, ophthalmic, .sphenopalatine Mi . ;m«l nibfl 

illary. 

Give the origin and distribution of the third division <>t t he 

fifth pair of nerves. 

tv rod from the Gasseriarj ganglion; motor root from the 
side oi the pons Varolii. The root-, unite and pass out of the skull th ■ 
the formen ovale, immediately dividing into anterior and posterior 
trunks. The anterior trunk gives oil branches to the meninges and t<> the 
muscles of mastication; the posterior trunk divides into the inferior dental, 

auriculotemporal, and lingual. The inferior dental supplies the mylohy- 
oid muscle and the teeth to the lower jaw; the aurirulo-temporal supplies 
the external meatus, parotid gland, temporomaxillary articulation, and 
temple; the lingual nerve supplies the anterior two-thirds of the tongue. 

Describe the fifth nerve. 

The first two divisions are sensory, the third retains both sensory and 
moter fibers. The superficial origin is from the side of the pons by two 
roots, the motor and sensory. Upon the sensory root is situated the 
lion, which rests upon the apex of the petrous portion of the 
temporal bone. The Gasserian ganglion divides into three division^: 
ophthalmic, superior maxillary, and inferior maxillary. 

The ophthalmic division leaves the skull through the sphenoidal 
fissure and divides into frontal, nasal, and lacrimal brandies. The 
second or superior maxillary division leaves the skull through the foramen 
rotundum, enters the spheno-maxillary fossa, there assists in the forma- 
tion of Meckel's ganglia, and enters the orbit through the spheno-maxil- 
lary fissure, finally leaving the orbit through the infraorbital canal, and 
appearing upon the surface of the face at the infraorbital foramen. The 
inferior maxillary division is joined by the motor root, leaves the skull 
through the foramen oval, divides into the anterior and posterior divisions, 
and supplies the muscles of mastication, the tongue, lower jaw, and a 
portion of the face. 

Describe the gustatory (lingual) nerve. 

It is a branch of the posterior division of the inferior maxillary portion 
of the fifth nerve. It is situated posterior to the external pterygoid muscle, 
and just before it enters the side of the tongue, it is joined by the clwrda 
tympani nerve — a branch of the seventh (facial). It supplies the anterior 
two-thirds of the tongue with common sensation. 

Give the nerve supply of the upper and lower teeth. 

The nerve supply of the upper teeth is derived from the second division 
of the fifth nerve through posterior, middle and anterior superior dental 
branches. The lower teeth are supplied by the inferior dental branch of 
the third division of the fifth nerve. 



IIO ANATOMY 

Give the origin and functions of the trigeminus (fifth cranial) 
nerve and name the divisions of the same. 

It arises from the side of the pons by two roots, a motor and a sensory. 
Functions: sensory nerve of the head and face, and motor nerve of the 
muscles of mastication. Divisions: ophthalmic, superior, and inferior 
maxillary. First two divisions are sensory, third is both sensory and 
motor. 

State origin, course, function, and distribution of sixth cranial 
nerve. 

Superficial origin from groove between the anterior pyramid of the 
medulla and the pons; deep origin from the floor of the fourth ventricle. 
The nerve pierces the dura on the basilar surface of the sphenoid to enter 
the cavernous sinus, where it lies to the outer side of the internal carotid 
artery. It enters the orbit through the sphenoidal fissure, passes between 
the two heads of the external rectus muscle, and terminates in its fibers. 
Function: motor nerve to the external rectus muscle. 

Give origin, course, and distribution of the seventh nerve. 

Deep origin from a nucleus in the pons ; superficial origin from the lat- 
eral border of the groove between the medulla and the pons. The nerve 
pierces the dura and enters the internal auditory meatus with the eighth 
nerve, and, at the bottom of the meatus, it passes into the aqueductus 
Fallopii. In this canal it traverses the temporal bone, making its exit 
from the skull through the stylomastoid foramen; it then passes forward 
in the substance of the parotid gland and divides into numerous branches 
at its anterior border to supply the buccinator muscle and the muscles 
of expression. This nerve sends communications to the fifth, eighth, 
ninth, tenth, and sympathetic nerves. 

Where does the glossopharyngeal nerve rise, and what 
structures are supplied by this nerve and its branches? 

Deep origin from the floor of the fourth ventricle; superficial origin 
from the upper portion of the medulla in the groove between the olivary 
and restiform bodies. The ninth nerve is the nerve of sensation to the 
mucous membrane of the pharynx, fauces, tonsil, and posterior third of the 
tongue; it also supplies the stylopharyngeus muscle and sends a branch 
to the tympanum (Jacobson's nerve). It is the nerve of taste for the 
prosterior third of tie tongue. 

What cranial nerve has the widest distribution? 

Pneumogastric (tenth). 

State the origin, exit, distribution, and functions of the pneu= 
mogastric nerve. 

Deep origin: the nucleus in the lower part of the floor of the fourth 
ventricle. Superficial origin: the groove between the olivary and restiform 
bodies. Exit through the jugular foramen. It supplies the organs of 
voice and respiration with motor and sensory, and the pharynx, esophagus, 
stomach, and heart, with motor fibers. 



' •\ini nc iii 

QfV€ the origin and distribution <>t (he hypoglossal nerve. 

/' from the il*»*>r ol the fourth ventricle 

from the tween the pyramid and olivary bodies ol tin- medulla. 

'l he nerve receives fibers from the first cervical nerve) which leave the 
nerve .t^ the descending hypoglossaJ and thyrohyoid branches. The 
twelfth nerve is the m§ior nerve of the ton 

What nerves supply the tongue? 

Motor, hypoglossal; > >: ^v, tlu- gustatory branch of the fifth; tc 
gloesophan ugesl, and chorda tympanj through anaat 
lory branch of fifth. 

What are the nerves of the evcball? 

Optic, motor oculi, and ophthalmic division of fifth (both through 

ciliary ganglion), and sympathetic fibers from cavernous plexus (also 

to ganglion). 

Describe the phrenic nerve. 

Derived from the fourth cervical nerve, it passes downward in the 
neck, upon the scalenus anticus muscle, and traverses the superior and 
anterior mediastinum to reach the diaphragm, lying between the pleura 
and pericardium in front of the root of the lung. Branches: muscular 
(to the diaphragm), pleural, pericardial, inferior vena cava capsular, and 
hepatic. 

What nerve supplies the muscles of expression? 

The facial, or seventh cranial nerve. 

Describe the sympathetic nerve, naming and locating the 
principal ganglia. 

It consists of a series of ganglia, situated on each side of the vertebral 
column, and connected together and to the cerebrospinal system by inter- 
vening nerves. The sympathetic nerve begins in the ganglion of Ribes, 
on the anterior communicating artery, and ends in the ganglion impar in 
front of the coccyx. 

The ganglia of the sympathetic are: ganglion of the cranium and face, 
Ribes on the anterior communicating artery, carotid in the carotid canal, 
cavernous in the sinus of same name. Cervical: superior, opposite second 
and third cervical vertebra behind the carotid sheath; middle, on the infe- 
rior thyroid artery just to the inner side of the carotid sheath; inferior 
opposite transverse process of seventh cervical vertebra to inner side of 
superior intercostal artery. 

There are twelve thoracic, four lumbar, four or five sacral, one coccygeal 
ganglia situated in relation with the spinal nerves of same name. There 
are three splanchnic nerves. The greater receives branches from the 
sixth to the tenth thoracic ganglia and terminates in the semilunar gang- 
lion; the lesser is derived from the tenth and eleventh dorsal gangh\. 
terminates in the celiac plexus; the least or renal is formed by the twelfth 
dorsal ganglia and ends in the renal and celiac plexuses. 



112 ANATOMY 

What is the solar plexus? 

The plexus consists of a network of nerves and ganglia lying in front 
of the aorta and crura of the diaphragm, and surrounding the celiac axis 
and root of the superior mesenteric artery. The plexus is formed by the 
greater and part of the lesser splanchnic nerves of both sides, the termina- 
tion of the right pneumogastric and the two semilunar ganglia. 

Describe the stylo=maxillary ligament. 

It extends from the styloid process to the inner surface of the ramus of 
the mandible. 

Compare aponeuroses with tendons. 

Aponeuroses are broad, flat sheets of fibrous tissue to which muscular 
fibers are attached, and serve as tendons of insertion for these fibers. Ten- 
dons are rounded (cord-like) or narrow (ribbon-like) bundles of fibrous 
tissue attaching muscles to bones. 

Name the muscles and ligaments attached to the inferior 
maxillary bone. 

Muscles: Masseter, temporal, external and internal pterygoid; genio- 
hyo-glossus, digastric, and mylo-hyoid. Ligaments: external and inter- 
nal lateral, capsular, stylo-mandibular, pterygo-mandibular. 

Describe the tensor palati. 

It is a muscle arising from the scaphoid fossa of the sphenoid and soon 
becomes tendinous. The tendon hooks around the hamular process and 
is inserted into the aponeurosis of the soft palate. 

Describe the palato=glossus muscle. Give origin, insertion, 
and nerve supply. 

Origin: Anterior surface of soft palate close to uvula; insertion: into 
side and substance of tongue; action: to constrict fauces and retract 
tongue; nerve supply: branch of spinal accessory. 

What muscles control the soft palate? 

Tensor palati and levator palati, azygos uviuas, palato-glossus and 
palato-pharyngeus. 

What muscles form the floor of the mouth? 

Mylo-hyoid and hypoglossus. 

What muscles have their origin from the styloid process, and 
where do they insert? 

The stylo-glossus into the side of the tongue; stylo-hyoid into the 
hyoid bone; stylo-pharyngeal into the lateral wall of the oral pharynx. 

Name and give the origin and insertion of the muscles which 
depress the lower jaw. 

Genio-hyoid. — Origin: Genial tubercle of the mandible; insertion: 
the body of the hyoid bone. Mylo-hyoid. — From the mylo-hyoid ridge of 



the mandible to tin- bod) ol the avoid I 

l r,,in geni it ■ the byoid and undei the 

I .in the •• mj lowei 

jaw t>> the hyoi l b 

Give the origin, Insertion, and action of the buccinator 

I dllary li ind alveolar p< 1 1 the 

superior and inferior maxillary 1><>; i Upper filx 

in for ming the lower portion of the orbicularis oris; lower 61 
the upper portion of the orbicularis oris. Actum: [odrs 
the mouth backward, keep the food between the teeth in mastication, 
and to assist in the formation of sounds. 

Name the muscles of mastication, and give their origin, in- 
sertion and nerve supply. 

Temporal. — Origin: Upper one-third of temporal fossa, and the 
aponeurosis covering the muscle. Insertion: Coronoid pi of the 

mandible. 

Masseter. — Origin: Lower margin of the zygomatic arch. Insertion: 
una! surface of the angle of the lower jaw. 

External pterygoid. — ( )ri^in: By two heads; one head from the external 
surface of the external pterygoid plate; the other from the pterygoid spine 
on the greater wing of the sphenoid. Insertion: Condyloid proa 
mandible. 

Internal pterygoid. — Origin: Internal surface of external ptcr. 
plate. Insertion: Inner surface of angle and ramus of the inferior maxilla. 
inator. — (See previous question.) 

They are all supplied by the third division of the fifth nerve. 

Give origin, insertion and nerve supply of the omohyoid. 

It is formed by two muscular slips with an intervening portion of 
tendon. The posterior extremity is inserted into the supra-scapular notch, 
the other end into the body of the hyoid bone. The intermediary tendon 
slip is held down to the first rib and clavicle by a process of deep cervical 
fascia. 

Action: To depress the hyoid bone, slightly elevate the scapula, and 
tensor of the cervical fascia. 

Nerve supply: Communicans hypoglossL 

Give the origin and insertion of the sternomastoid muscle. 

Origin: By two heads, one from inner third of superior border of 
clavicle, the other from front of manubrium sterni. Insertion: Into mas- 
toid process and outer half of superior curved line of occipital bone. 

Describe the occipito=frontalis muscle. 

Arises from outer two-thirds of superior curved line of occipital bone 
and from mastoid bone as posterior belly, and blends with centrally 
placed aponeurosis on vertex, which is continued forward into ante- 
rior belly, the latter being united to the orbicularis palpebrarum, 
S 



114 ANATOMY 

corrugator supercilii and pyramidalis nasi. Action: To raise brows, 
produce transverse wrinkles of forehead, and move scalp backward 
and forward. 

Mention the muscles attached to the hyoid bone. 

Genio-hyo-glossus, geniohyoid, mylohyoid, stylohyoid, aponeurosis 
of digastric, hyoglossus, middle constrictor of pharynx, sternohyoid 
thyrohyoid, omohyoid. 

Mention the muscles attached to the occipital bone. 

Twelve pairs: Occipito-frontalis, sternomastoid, trapezius, splenius 
capitis et colli, complexus, obliquus capitis superior, rectus capitis anticus 
major and minor, rectus capitis posticus major and minor, rectus capitis 
lateralis and superior constrictor of pharynx. 

Name the muscles of the tongue and their attachments. 

Intrinsic: divisions of lingualis. Extrinsic: genio-hyo-glossus, hyo- 
glossus, stylo-glossus, palato-glossus. 

Lingualis consists of superior lingualis (longitudinal fibers), transverse 
lingualis, inferior lingualis, and vertical lingualis. These bundles and 
strata of muscular fibers intersect each other, being attached to under 
surface of mucous membrane and to raphe. 

Genio-hyoglossus: origin, superior genial tubercle; insertion, deep 
surface of tongue and body of hyoid bone. Hyoglossus: origin, body, 
greater and lesser cornua of hyoid; insertion, side of tongue. Stylo- 
glossus: origin, styloid process; insertion, side of tongue. Palato-glossus: 
origin, anterior surface of soft palate; insertion, side of tongue. 

Give the muscles of facial expression. 

Occipito-frontalis, corrugator supercilii, orbicularis palpebrarum, 
levator labii superioris alaeque nasi, levator labii superioris, levator anguli 
oris, zygomaticus major and minor, orbicularis oris, depressor anguli oris, 
depressor labii inferioris and platysma myoides. 

What muscles assist in (a) mastication? (b) in deglutition? 

(a) Temporal, internal, and external pterygoids, masseter, and bucci- 
nator, (b) Mylohyoid, digastric, stylohyoid (first part of act) ; omohyoid, 
sternohyoid, sternothyroid, thyrohyoid (second part of act). 

Give the origin, insertion, and action of any one of the fol= 
lowing muscles: digastric, soleus, and rectus abdominis. 

The digastric consists of two bellies. The posterior belly arises from 
the digastric groove on the mastoid process; the anterior from the man- 
dible close to the symphysis. The two bellies are connected together by a 
tendon, which is attached to the hyoid bone by a pulley-like band of deep 
fascia. Action: To assist in elevating the hyoid bone. 

Give boundaries of the anterior triangles of the neck and give 
the origin and insertion of the muscles forming the boundaries. 

The large anterior triangle is bounded above by the lower jaw, an- 
teriorly by the middle line of the neck, and posteriorly by the anterior 



bordei ol the rternomastoid n hit trian Into 

imaller triangles b) I and the 

■ ior belly ol tin- diagastric. 

Hie iiu« bounded ant • midline 

<>f the neck, behind i>y tfu- rternomastoid, ab terior belly ol 

the omohyoid. I be bounded below by the anterior belly 

of tlu- omohyoid, behind by the Bternomastoid, above by the 
belly ol the digastric The mbmaxil bounded anteriorly by 

the anterior belly of the digastric, behind by the >r belly of the 

trie, above by the lower jaw, 

id: origin, nppei pari of the sternum and inner portion 
of the clavicle; insertion, mastoid process and superior curved lii 

the Occipital hone. 

( Omohyoid: origin, upper honler of the scapula near suprascapular 

notch; insertion into body oi hyoid hone. This mux le has two bellies 

connected by a central tendon, which is attached to the first rib by a pulley- 
like band of deep fascia. 

Bound the posterior triangle of the neck. 

It is bounded anteriorly by the sternocleidomastoid; posteriorly, by 
the trapezius; beUfW, by the clavicle. 

Describe the submaxillary triangle, and name the principal 
structures in it. 

It is a triangular space situated below the body of the mandible. It is 
bounded above by the mandible, below, by the anterior and posterior bellies 
oi the digastric, lis floor is formed by the mylohyoid and hypoglossus 
muscles. It contains the submaxillary gland and facial arterv and vein" 

Describe the diaphragm, its principal openings, and nerve 
supply. 

The diaphragm is a musculofibrous partition separating the cavities of 
the thorax and abdomen. The lower concave surface is in relation with 
the liver, stomach, and spleen; the upper surface is in relation with the 
pericardium, pleura, and chest wall. It arises anteriorly from the ensiform 
cartilage; laterally from the inner surface of the lower six ribs by fleshy 
bands which interdigitate with the transversalis muscle; posteriorly, from 
the lumbar vertebra? by two crura. 

The opening for the vena cava is situated in the right leaflet of the 
central tendon; the esophageal opening is in the muscular substance be- 
hind the central tendon; the aortic opening is situated between the crura 
and beneath the middle arcuate ligament. 

The nerve supply is derived mostly from the phrenic, but also from the 
lower intercostals and sympathetic. 

State the difference between compact bone and spongy bone. 

Compact bone is dense, being composed of layers of calcined material 
called lamella:. The lamellae surrounding the circumference of the bone 
are called concentric lamella:; those throughout the bone, Haversian 
systems. 



Il6 ANATOMY 

Spongy bone is loosely constructed, being composed of an interlace- 
ment of calcined septa. 

Describe the periosteum. 

The membrane which surrounds the bone. It consists of two layers 
closely united together — the outer layer consists chiefly of connective 
tissue; the inner layer of elastic fibers, which can be separated into several 
layers. This membrane supplies the surface of the bone with blood and 
assists in its growth. 

What is perichondrium? 

A fibrous investment surrounding cartilage. It consists of an outer 
fibrous, and an inner chondrogenetic layer. 

State where marrow is found. Describe the varieties of 
marrow. 

Marrow is contained in the spaces in the interior of bones, whether 
the large medullary cavities surrounded by the compact substance forming 
the tubular shaft of the long bones or the irregular interstices between the 
trabecular of the cancellated tissue. The marrow in the adult is of two 
kinds — the red and the yellow. In the shaft of the long bones marrow ap- 
pears as a light, yellowish tissue. Within the ends of the long bones, 
vertebrae, ribs, sternum, and diploe of the cranium, the color is a dull red. 

Describe an Haversian system. 

Each Haversian system consists of the concentrically disposed lamellae 
and the centrally situated channel, or Haversian canal, enclosing the 
ramifications of the medullary blood-vessels and associated marrow-tissue. 
Between the circularly arranged lamellae are seen small oval spaces, the 
lacunce, from which extend minute channels, the canaliculi, establishing 
communication between the adjacent lacunas of the same Haversian 
system. 

Mention two methods of bone formation. Describe one. 

Cartilaginous or endochondral and intramembranous . In endochon- 
dral bone formation the shape of the bone is first laid down in cartilage. 
The cartilage cells are gradually absorbed, their place being taken by 
osteoblasts or bone cells, which are derived from the periosteum. In this 
way the bone finally becomes ossified. 

Mention the sutures at the vertex of the skull and state what 
bones they unite. 

The sagittal suture unites the two parietal bones; the lambdoidal, the 
occipital with both parietals; the coronal, the two parietals with the fron- 
tal. 

Give the number and names of the bones forming the cra= 
nium; face. 

There are eight bones in the cranium, viz., occipital, two parietal, 



El 11 

frontal, two temporal, iphenoid, and ethmoid. ■ ! the 

face two nasal, tWO Superior maxillary. tWO la<rim.il. tWO Dalai 
palate, tv. r turbinated, \oinci, ami interior maul! 

\\ hat are the toiitanelles? 

They an- membranous intervals m the Infant's ikull, oo 
to the junction of the tour angles o! the parietal with th< 
They are ni in number; anterior, poatei loi and two lateral on eith< i 

Describe the spinal column. 

it consists ^\ 33 vertebrae, seven cervical, twelve thoracic, five lumbar, 
five sacral, four coccygeal. Sai ral ami c early in life by 

ossification oi intervertebral Bubstances; cervical segment p curve 

with convexity forward, thoracic with convexity backward, lumbar 
with convexity forward, sacral with convexity backward; line- of gravity 
passes through chords of these curves. Special, or peculiar, vertebrae are: 
atlas, axis, seventh cervical (vertebra prominens). The ribs articulate 

the thoracic series. Spinal column contains neural canal for spinal 

Describe one of the vertebrae. 

Each vertebra consists of two essential parts, an anterior solid >eu r ment 
or body and a posterior segment or arch. The arch is formed by two 

pedicles and two lam'nuc, which support seven processes, two superior and 
two inferior articular, tWO transverse I extending laterally from the pedicles), 

and a spinous process, the continuation posteriorly of the lamina-. 

Name the foramina at the base of the skull and the structures 
transmitted through each. 

Foramen magnum: transmits the spinal cord and meninges, the spinal 
portion of the spinal accessory nerves, and vertebral arteries. Posterior 
condyloid (inconstant): veins, anterior condyloid (two), and hypoglossal 
nerves. Mastoid: emissary vein. Jugular foramen: lateral and inferior 
petrosal sinuses, glossopharyngeal, pneumogastric, and spinal accessory 
nerves. Middle lacerated foramen: nothing. Carotid canal: the carotid 
artery and sympathetic plexus. Foramen spinosum: middle meningeal 
artery. Foramen ovale: mandibular division of the fifth nerve. Foramen 
rotundum: superior maxillary division of the fifth nerve. Vidian canal: 
Vidian nerve. Optic foramen: optic nerve and ophthalmic artery. 
Sphenoidal fissure: motor oculi, trochlear and abducens nerves, oph- 
thalmic division of the fifth nerve, and ophthalmic vein. Olfactory 
foramina: olfactory nerves. 

What bones form the orbital cavities? 

Frontal, ethmoid, sphenoid, lacrimal, superior maxillary, palate, and 
malar. 

What bones enter into the formation of the nasal fossa?? 

Frontal, sphenoid, ethmoid, two nasal, two superior maxillary, two 
lacrimal, two palate, two inferior turbinated, and vomer. 



Il8 ANATOMY 

Describe the nasal fossae. 

They are two large, irregular cavities situated on each side of the middle 
line of the face. They extend from the base of the cranium to the roof 
of the mouth, and are separated from each other by a thin vertical septum. 
They communicate with the face by the two anterior nares and with the 
pharynx by the two posterior nares. 

The roof is formed by the following bones: nasal, cribriform plate of the 
ethmoid, body of the sphenoid, sphenoidal process of the palate, and the 
ala of the vomer; the floor by the palatal process of the superior maxilla 
and the palate bones; the inner wall by a septum consisting of the crest 
of the nasal, the nasal spine of the frontal, the perpendicular plate of the 
ethmoid, the vomer, the rostrum, and the ethmoidal crest of the sphenoid; 
the outer wall by the nasal, nasal process of the superior maxilla, lacrimal, 
ethmoid, superior maxilla, inferior turbinated, vertical plate of the palate, 
and the internal pterygoid plate of the sphenoid. 

It has three longitudinal passages (meatus) ; superior, situated between 
the superior and middle turbinate; opening into it are the sphenopalatine 
air-cells and the posterior ethmoidal cells. The middle meatus is between 
the middle and inferior turbinate bones; opening into it are the antrum 
and infundibulum. The inferior meatus is between the inferior turbinate 
and the floor of the nasal cavity; opening into it is the nasal duct. 

Describe the nasal bone and give its articulations. 

It is a small, oblong bone which, together with its fellow of the opposite 
side, forms the roof of the nose. It articulates with the ethmoid, superior 
maxillary, frontal and opposite nasal bones. 

Mention the bones that form the septum of the nose. 

In front, the crest of the nasal bones and the frontal nasal spine; 
middle portion, the vertical plate of the ethmoid ; behind, the rostrum of the 
sphenoid, the vomer, and the sphenoidal crest; below, the crests of the 
superior maxillary and palate bones. 

Describe the mandible. 

The inferior maxillary bone consists of a horseshoe-shaped body and a 
ramus. The ramus is prolonged into two processes — one the coronoid 
process, and the other the condyloid process. Between the two is situated 
the sigmoid notch. The portion of the body into which the teeth are 
inserted is called the alveolar margin. On the inner surface of the ramus 
is situated the inferior dental foramen. This canal continues through 
the center of the bone until it reaches the mental foramen, which is situated 
on the external surface of the jaw, opposite the canine tooth. The line 
of union of the two sides is called the symphysis. On the posterior 
surfaces of the symphysis are situated the genial tubercles. 

Describe the superior maxilla. 

The bone consists of a hollow body and four processes. The body is 
cuboidal in form and hollowed out in the center into a pyramidal cavity, 
the antrum of Highmore. It has four surfaces, an external, which looks 
forward and outward; a posterior convex surface, which forms part of the 
zygomatic fossa; a superior surface (orbital plate), which forms part of 



I 
the Boor of the orbit; and an Internal, irhich Forms pari «»i' the outei I 

of the nasal t'o»a and t hi* mouth. The hone haS/MM .tl.ir, 

nasal, alveolar, ami palatine, it artictdoiei with the foilowii 

the opposite maxilla, tuberosity of tin- palate by the 

the palate in the flooi of the orbit, and the ethmoid, uu rimal, malar, nasal, 

and interior turbinated. 

Name the articulations of the occipital hone. 

Atlas, tWO parietal, two temporal, and >phrnoid. 

With wfaaf hones does the frontal articulate? 

Both parietal, both malar, both nasal, both lacrimal, both maxill.r 

(superior), ethmoid, and sphenoid. 

Describe the maxillary sinus and its relation to the teeth. 
The maxillary sinus is a cavity hollowed out in the center of the 

Superior maxillary hone, and normally opens into the middle meat 
the nose. The root- of the two bicuspids and first molar teeth make dis- 
tinct elevations upon the lower inferior surface of the cavity. 

What bones form the orbit? 

The frontal, sphenoid, malar, superior maxillary, ethmoid, and lacri- 
mal. 

Describe the zygomatic arch, and name the muscle that 
passes under it. 

The zygomatic arch is formed by the zygomatic process of the tem- 
poral bone uniting with a like process from the malar bone. The tem- 
poral muscle passes under it. 

Describe the spheno=maxillary fossa. What important 
structures are found in it? 

It is a fossa situated between the pterygoid process of the sphenoid 
and the posterior wall of the superior maxillary bone. The foramen 
ovale opens into it, and the spheno-maxillary fissure leads from it into the 
orbit. It contains the second divsion of the fifth nerve and Meckel's 
ganglion. 

Name the structures that pass through the foramen magnum. 

Spinal cord, meninges, spinal portion of the spinal accessory nerve, 
two vertebral arteries, anterior and posterior spinal arteries. 

Describe the vomer. 

It is a single, plowshare-shaped bone, placed vertically in the nasal 
fossa?, and forming part of the nasal septum. It articulates with the sphe- 
noid, ethmoid, palate, superior maxillary, and nasal cartilage. Its 
lateral surface is grooved for the nasal-palative nerve. 

Describe the sphenoid bone. Name the bones with which 
it articulates. 

It consists of a body, two greater, and two lesser wings, and two 



120 ANATOMY 

pterygoid processes. The center of the body is hollowed out to form the 
sphenoidal air cells. Upon the anterior surface of the body is a depression 
called the pituitary fossa, for the lodgment of the pituitary body. The 
two lesser wings assist in forming the posterior portion of the anterior 
cerebral fossa. The greater wings form the anterior portion of the middle 
fossa of the skull. Bounded by the lesser wings above, the greater below, 
and the body of the sphenoid internally, is the sphenoidal fissure, which 
gives passage to the third, fourth, first division (ophthalmic) of the fifth, 
and the sixth cranial nerves, with the ophthalmic vein. In the greater wing 
of the sphenoid, from before backward, are found the foramen rotundum, 
for the exit of the second division of the fifth nerve; the foramen ovale, 
for the third division of the fifth nerve; and the foramen spinosum, for the 
passage of the middle meningeal artery. It also assists in forming the 
middle lacerated foramen. The two pterygoid processes hang from the body 
and the inner portion of the greater wings, and consist of an outer, and an 
inner plate, with the pterygoid fossa situated between the two. 

The sphenoid bone articulates with the ethmoid, frontal, parietal, 
temporal, malar, palate, vomer, and occipital bones. 

Describe the ethmoid bone. 

The ethmoid is a spongy bone situated at the base of the anterior fossa 
of the skull and inner wall of the nose. It consists of four parts: the 
horizontal or cribriform plate, two lateral masses, and the perpendicular 
plate. The cribriform plate derives its name from the fact that it is per- 
forated for the transmission of the olfactory nerve filaments. It forms the 
middle portion of the anterior cerebral fossa. Under the cribriform plate, 
and directly continuous with the crista galli above, is the perpendicular 
plate, which forms part of the nasal septum. It is usually deflected to 
one side. The lateral masses contain three air cells. On their inner sur- 
faces are two curling pieces of bone, called the middle and superior turbi- 
nates. On the under surface of each lateral mass, projecting downward 
and backward, is the unciform process, which helps to form a portion of the 
inner wall of the antrum. 

Describe the frontal bone and give its articulations. 

It consists of a vertical and a horizontal plate. Where the vertical 
and horizontal plate come together is formed the supraorbital margin. At 
this point, between the internal and external plates, is situated the frontal 
sinus. The horizontal plate assists in forming the anterior fossa of the 
skull and roof of the organ. The vertical plate forms the forehead. At 
the inner third of the supraorbital margin is situated the supraorbital 
foramen, for the exit of the supraorbital nerve and artery. It articulates 
with the parietals, two malar, two nasal, two superior maxillary, two 
lacrimal, two ethmoid and sphenoid. 

Describe the temporal bone. 

It consists of three parts: the squamous, petrous, and mastoid portions. 
The squamous portion is shell-like and forms the inner wall of the tem- 
poral and the outer wall of the middle fossa of the skull. At its base 
is situated the zygomatic process, which is formed by the anterior and 



riCULATIONS OF THE JAW IS] 

posterior rOOt B i.ited th. 

artu ulation with tin- !>•.. 

Th. ular cone which divides the middle from 

theposterioi fossa oi the skull. The interior contains the organ of hearing, 

the Eustachian tube, anil the carotid canal. It . the formation 

of tin- jugular ami middle la* erated foramen. 

The Is a cone shaped process which hangs from the 

po a tero-lateral portion of the skull, ami contains tin- mastoid air <tll\. 
It ha the externa] surface \ ailed tin- & 

tween the squamous ami mastoid portions is situated the external am 
ilow which springs the styloid proo 

Describe the temporo-mandibular joint. 
The bony parts forming the joints are the glenoid fossa, tin- arti< ulat- 
ing eminence <>t" the temporal hone, ami the condyle of the mandible. 

situated between the condyle ami the other bony parts is tin- inter articular 
fibro cartilage. There Is a separate synovial sheath between the articular 
cartilage ami the condyle; also one between the glenoid fossa and the 

articular cartilage. The joint is surrounded by a capsular, and reinforced 
by an internal and an external lateral ligament. 

Describe the glenoid fossa. 

It is situated upon the inferior surface of the squamous portion of 
the temporal hone, heing formed by the anterior and posterior root- of 
goma and the ( ias-erian fissure. It is lined with synovial membrane. 
The condyloid portion of the mandible articulates with it. 

Name the articulations of the superior maxillary bone. 

With mne bones: two of the cranium, the frontal and ethmoid; seven 
of the face: nasal, malar, lacrimal, inferior turbinated, palate, vomer, and 
opposite maxilla. 

Mention the muscles and ligaments attached to the ramus of 
the jaw. 

The muscles attached to the ramus are the masseter, internal and 
external pterygoid, buccinator, and temporal. The ligaments are the 
capsular, external and internal lateral of the temporomaxillary articula- 
tion, and the stylomaxillary. 

Describe the hyoid bone. 

The hyoid is a bony arch, shaped like a horseshoe. It consists of 
five segments: a body and two great and two lesser cornua. It gives 
attachment to the sternothyroid, sternohyoid, stylohyoid, digastric, mylo- 
hyoid, geniohyoid, geniohyoglossus, and the following ligaments: stylo- 
hyoid, thyrohyoid, and the thyrohyoidean membrane. 

Name and locate the accessory sinuses and describe their 
outlets. 

The frontal sinus is situated between the inner and outer tables of the 
frontal bone, at the junction of the horizontal and vertical plate. It 



122 ANATOMY 

opens into the middle meatus of the nose, in conjunction with the anterior 
ethmoidal sinus, by means of the infundibulum. 

The ethmoidal sinus usually consists of three separate cavities, named 
the anterior, middle, and posterior. They are situated in the lateral 
mass of the ethmoid bone. The middle and posterior empty into the 
superior meatus. 

The maxillary sinus (antrum of Highmore) is a cavity hollowed out 
in the superior maxillary bone. It communicates with the middle meatus 
of the nose. 

Describe the thorax. 

It is conical in shape, and its framework is formed by the bodies of 
the dorsal vertebrae behind, the ribs laterally, and the costal cartilages and 
sternum in front; the base is formed by the diaphragm. Through its 
apex pass the great cervical vessels, the pneumogastric, phrenic and 
sympathetic nerves, the trachea, esophagus, thoracic duct, and apices of 
the lungs, covered by pleura. 

Name the principal structures in the thorax. 

The trachea and lungs; the heart and great vessels; the thymus gland; 
pneumogastric, sympathetic, and phrenic nerves; the thoracic duct and 
esophagus. 

Give the classification of joints with an example of each. 

Synarthrosis or immovable, as in sutures of the skull. Amphiar- 
throsis or slightly movable, as the joints between the vertebrae. Diar- 
throsis or movable, as the knee-joint. 

Differentiate synarthrosis, amphiarthrosis, and diarthrosis, 
giving an example of each. 

Synarthrosis is an immovable joint consisting of two bones placed 
edge to edge with little or no fibrous tissue intervening; example: lamb- 
doid suture. Amphiarthrosis is a joint, permitting of slight motion, made 
up of two bones with an intervening fibrocartilaginous plate or disk, and 
held together by ligaments; example: joints formed by bodies of the 
vertebrae and intervertebral disks. Diarthrosis is a freely movable joint 
consisting of two or more bones with articular surfaces covered with 
hyaline cartilage, lined with synovial membrane, and surrounded by 
ligaments. Example: hip-joint. 

What is connective tissue? Where in the body is connec= 
tive tissue found? 

By the term connective tissue we mean a number of tissues which 
possess the following feature in common: that they serve the general 
purpose in the animal economy of supporting and connecting the tissues 
of the frame. The principal forms are white fibrous, yellow elastic, and 
areolar. It is distributed throughout the body and forms the sheaths of 
muscles, blood-vessels, and nerves, also ligaments, tendons, etc. 

Describe the gross anatomy of the larynx. 

The larynx is the organ of voice, situated at the upper part of the air- 



passage it fa lituated between the trachea and the base of tl 
In the upper and few pan of the neck, ui 

i don In the middle lint-. Behind, it form 
boundary of tin* phai) ax, and la * overed by the mu< oua membrane lining 
tli.it cavity, The larynx i- broad above, prhere it presents the 
of a triangular box, Battened behind and al the ii 
and cylindric It is composed of the following cat vroid, cri 

epiglottis, two arytenoid, two cornicula, and two cuneiform. The< 
lages are connected together by iigamenta and moved by num< 
muscles, The Interior ia lined by mucous membrane. The 
aperture is wide in front an<l narrow behind; it i.s bounded above by the 
epiglottis. The cavity of the larynx extends from the superior aperture 
to the lower border of the cricoid cartilage and i^ divided into two part-. 

by the true vocal cords. The sparr between the true <<>nU i- tailed the 

glottis, the boundary ^'\ which i- called the rima glottidis. The true 
eor<ls extend from the angles of the arytenoid cartilages to the receding 
angle of the thyroid; above the true cords are the false: between them is 
a cavity called the ventricle of the larynx. 

The blood supply is derived from the superior and inferior thyroid. 
The superior laryngeal nerve pierces the thyrohyoid membrane and sup- 
plies sensation to the interior of the organ; the recurrent laryngeal is the 
motor nerve to all the muscles excepting the cricothyroid, which is sup- 
plied by the superior laryngeal. 

Name and locate the cartilages of the larynx. 

Thyroid, cricoid, epiglottis, two arytenoid, two cuneiform, and two 
cornicula. The thyroid consists of two ake united in front at an acute 
angle; the upper border is attached to the hyoid bone by the thyrohyoid 
membrane, the lower border articulates with the cricoid on each side and 
is connected to the cricoid by the cricothyroid membrane anteriorly. 
The cricoid is ring-shaped and united to the thyroid as given above. Its 
lower border is connected to the upper ring of the trachea by a fibrous 
membrane. The arytenoids are triangular, and rest on the posterior 
upper surface of the cricoid. The epiglottis is placed behind the tongue, 
in front of the superior opening of the larynx; the anterior portion is free; 
the posterior portion is connected to the angle between the thyroids by 
the thyro-epiglottic ligament. The cornicula surmount the apices of the 
arytenoid cartilages. The cuneiform are contained in the aryteno- 
epiglottidean folds. 

Describe the arytenoid cartilages. 

They are two in number, and each is situated at the upper border of the 
lamina of the cricoid cartilage. Each cartilage is pyramidal in form and 
presents for examination three surfaces, a base, and an apex. It articu- 
lates with the cricoid and cartilage- of Santorini, and gives attachment to 
the true vocal cords and the following muscles: crico-arytenoid, arytenoid, 
and thyro-arytenoid. 

Give the anatomy of the true vocal cords. 

The true vocal cords are placed below the false cords; they extend from 
the angle between the ake of the thyroid cartilages to the vocal processes of 



124 ANATOMY 

the arytenoid cartilages. The cord is sharp and prominent; the investing 
mucous membrane is covered by stratified squamous epithelium. 

Describe the trachea. 

The trachea is a cartilaginomembranous cylindric tube, slightly flat- 
tened posteriorly. It is kept patent by a series of cartilaginous rings, which 
are deficient posteriorly. It begins above at the lower border of the cri- 
coid cartilage, opposite the sixth cervical vertebra; from this point it 
extends downward through the lower part of the neck into the superior 
mediastinum, ending opposite the fifth dorsal vertebra by dividing into 
the right and left bronchus. The caliber is variable; it exhibits a slight 
dilatation about the middle, and another at the bifurcation. 

What structures are severed in tracheotomy? 

Skin, superficial and deep cervical fascia. The sternothyroid muscle is 
separated from its fellow and the pretracheal fascia and tracheal rings are 
divided. 

Describe the pleura. 

The pleura is a serous membrane covering the lungs (visceral layer), 
thoracic surface of the diaphragm, and the inner surface of the wall (parie- 
tal layer) . 

Give an anatomic description of the bronchial tubes. 

They are two tubes, structurally like the trachea, extending from its 
bifurcation into the lungs, dividing and subdividing, and gradually losing 
their cartilaginous character, until the diameter of one-fourth of a line is 
reached, when they become entirely membranous. The tubes are lined 
by ciliated columnar epithelium. The right bronchus is wider, about i in. 
snorter, and more horizontal than the left. The blood supply is derived 
from the inferior thyroid and aorta. The veins empty into the thyroid 
plexus and the lymphatics into the bronchial glands. The nerves are 
branches of the pneumogastric and sympathetic. 

Describe the lungs. 

The lungs are pyramidal-shaped bodies situated one in each half of the 
thorax ; they are connected to the trachea by bronchi, and to the heart by 
veins and arteries. The base of the pyramid rests upon the diaphragm. 
The right lung is larger, containing three lobes; the left, two lobes. The 
lungs enlarge during inspiration, and decrease in size with expiration. 
They are formed by a bronchial tree, which divides and re-divides until you 
have small terminations called bronchioles. Around each bronchiole are 
situated a number of air cells, where the interchange between the blood 
and the air takes place. The lungs are surrounded on the external sur- 
face by a serous membrane called the pleura. The pulmonary veins carry 
the oxygenated blood back to the heart. The bronchial arteries furnish 
the blood supply; the nerve supply is the pneumogastric and sympathetic. 

What are cilia and what are their functions? 

They are fine, hair-like prolongations of a cell. They occur on sur- 
faces where fluids or bodies are to be propelled as in the Fallopian tube. 



lin rONGl i 

Name the subdivisions <>f the alimentary canal and five the 
name and location «>i the various glands found In the small 
Intestine* 

Mouth, pharynx, esopha mach, duodenum, jejunum, il. 

ascending, transvei pnoid colon, rectum, and i 

The glands In the small intestine are: duodenal (Bran i und 

In the duodenum; intestinal follicles (crypta of LieberkUhn), found In 
the whole length of the small and large intestine; and solitary gland 
I 'a pat< hes, found in all parts of the small intestine, but most numer- 
ous in the ileum. 

Describe the grass anatomy of the tongue. 

The base is attached to the hyoid and inferior maxillary bones by 
mUSCleS, to the epiglottis by two lateral, and one median gli lottic 

folds of mUCOUS membrane, and to the soft palate by the anterior pillars. 
'I'he tip, sides, dorsum, and part of the under surfai e are free. A median 

raphe or fibrous septum divides the organ into halves. The mucous mem- 
brane under the tip forms a fold called [}\c Jrcnum lingua. The tongue 
is formed by the intrinsic lingualis muscle. The extrinsic musck 
the Styloglossus, hyOglosSUS, geniohyoglossus, and palatoglossus. 

Describe the papillae of the tongue. 

The circumvallatc, eight to ten in number, arc arranged on the back 
pari of the dorsum in two lines converging posteriorly like a letter Y; 
behind the apex of the Y is a little depression, the foramen an urn (remains 
of thyroglossal duct). The fungiform are scattered over the dorsum, 
but chiefly on the sides and tip. The filiform or conical papilhe are found 
in great numbers scattered over the anterior two-thirds of the organ. 

Give the blood supply of the tongue. 

Lingual and ascending pharyngeal arteries. 

Name the nerves supplying the tongue and give their func= 
tion. 

Motor nerve, twelfth. Special sense, ninth, and chorda tympani from 
the seventh. Common soisation, lingual branch of the third division of 
the fifth. 

Describe the pharynx. 

The pharynx is the upper portion of the digestive tube. It communi- 
cates with the mouth, larynx, nasal cavities, Eustachian tubes, and esoph- 
agus. It extends from the base of the skull to the sixth cervical vertebra 
(lower border of cricoid cartilage). It is divided into the nasal, oral, and 
laryngeal pharynx. The pharynx is a musculomembranous sac about 
four inches in length, broader transversely than anteroposterior!}-. In the 
nasal pharynx are situated the pharyngeal tonsils and the orifices of tJic 
Eustacliian tubes; the space posteriorly to the tubes in the lateral wall is 
called the lateral recess {fossa of Roscnmiiller). The oropharynx is the 
portion between the soft palate and the superior border of the larynx; it 
contains the faucial tonsil. The laryngeal pharynx is tha^ portion situated 
behind the larynx; it contains the sinus pyriformis. The blood supply is 



126 ANATOMY 

derived from the internal maxillary and facial arteries. Nerve supply is 
derived from the ninth and tenth nerves and the sympathetic system. 

Name the seven openings into the pharynx. 

Larynx, mouth, esophagus, two Eustachian tubes, and two posterior 
nares. 

Describe the esophagus as to (a) location, (b) dimensions, 
and (c) arterial supply. 

The esophagus extends from the cricoid cartilage to the cardiac end of 
the stomach. In the neck it lies between the trachea and the vertebral 
column and longus colli muscle; in the lower part of the neck it inclines to 
the left, having on each side the common carotid artery and the lateral lobe 
of the thyroid gland. The recurrent laryngeal nerves ascend between the 
esophagus and the trachea. In the thorax the esophagus is at first slightly 
to the left; after passing posterior to the aortic arch it descends in the pos- 
terior mediastinum along the right side of the aorta to the diaphragm, 
where it passes in front previous to entering the abdomen. 

(b) In length it usually measures about 10 in. (25 cm.). Its breadth, 
where the tube is widest, varies between 1/ 2 in. (13 mm.) in the empty con- 
tracted condition and 1 in. or more (25 to 30 mm.) in the fully distended 
state. 

(c) The arterial supply is derived from the inferior thyroid, descending 
aorta, and gastric branch of the celiac axis. 

Describe the stomach, give its average size, attachments, 
regional location and gross structure. 

The stomach is irregularly pyriform in shape, with a wide or cardiac 
end directed backward and to the left, and a narrow pyloric end which 
extends to the right to join the duodenum. In addition to its two ends, the 
stomach presents for examination the following parts: two curvatures, 
greater and lesser, which separate the superior and inferior surfaces; and 
two orifices, the esophageal orifice or cardia and the pyloric orifice or 
pylorus. Probably no organ in the body varies more in size, within the 
limits of health, than the stomach. Consequently it is difficult, perhaps 
impossible, to arrive at a correct estimate of its size and capacity. The 
length in the fully distended condition is about 10 to n in. (25 to 27 cm.), 
and its greatest diameter not more than 4 to 4 1 / 2 in. (10 to 1 1 cm.). The 
capacity of the stomach in the average state rarely exceeds 40 oz., or 1 
quart. 

The stomach is attached to the spleen by the gastrosplenic omentum, 
to the diaphragm by the gastrophrenic ligament; the lesser curvature is 
attached to the under surface of the liver by the lesser omentum. It is 
located in the left hypochondriac, epigastric, and part of the right hypo- 
chondriac regions. The stomach is composed of four coats — namely, 
from without inward: (1) peritoneal, (2) muscular, outer longitudinal, 
middle circular, and inner oblique, (3) submucous, and (4) mucous 
membrane. 

Describe the mucous coat of the stomach. 

It is soft, velvety, easily movable on the lax areolar tissue, thickest near 



III. kl\ 

the pylorus, and presents mtnj fol 

tudinal. I In- membrane I ered with tall, columnar epithelium. 
I he ffandi constitute two prim i j ».i I the fmdai and tl 

The fundaJ »>r A r /•::, gbmds * onsist of numerou . 1 1<» <l> • <i tubule whi< h 
extend through the entire thid 1 1 1 « - mucosi rhc cell lining 

isirir tUDUleS arc of two kinds, the ( liii-t" and parietal. 

ceils notably secrete pepsin, the parietal secrete hydrochloric add. 

Describe the pyloric glands of the stomach. 

They arc i>i the branched tubular type, with wide and d< 
duets but very tortuous gland tubules. They are lined with low colum- 
nar epithelium. The .same t\ pe i> continued in the duodenal or Hrunner's 
glands. 

Describe Peyer's patches. 

They are present in the lower half of the small intestine, e>pe< (ally in 

the ilium. The patches appear as slightly raised, elongated oval area-. 

Bach patch contains from twenty to thirty ovoid individual lymph nodules 
which, when well developed, occupy both the mucous and submucous 
They are about thirty in number. 

Describe the liver. 

The liver is the largest gland in the body. It is of the compound 
racemose type; has five lobes, five fissures, and five ligaments. It re- 
ceives venous blood from the portal system, blood for nourishment from 
the hepatic artery, and is drained by the hepatic vein. It secretes bile, 
which is emptied into the first portion of the intestine through the com- 
mon bile duct. 

Describe the structure and state the functions of the skin. 

It consists of the cutis vera, formed of fibrous tissue, the superficial 
layer forming papilhc. This layer contains the blood-vessels and end 
bulbs of the sensory nerves. It is covered by epithelium. There are 
four layers of epithelium; outer or stratum corneum; stratum lucidum; 
stratum granulosum, and inner, or stratum mucosum. The skin protects 
the underlying tissues from injury, and drying, and furnishes a means of 
evaporation and excretion. 

Give the composition of the sweat glands. 

Modified simple tubular in type, each gland consists of two chief 
divisions (i) the body or gland-coil, the tortuously wound tube in which 
secretion takes place, and (2) the excretory duct, which opens on the 
surface of the skin. 

Give a brief description of the visceral arches. 

They are the homologues of the gills of fish. They are five in number: 
First, mandibular; second, hyoid; the remaining three are called branchial 
arches. 

From the first visceral arch are developed all of the superior maxillary 
bone, with the exception of the premaxillary portion ; the inferior maxillary 
bone; and the malleus and incus of the ear bones. From the second arch 



128 ANATOMY 

are developed the stapes, a portion of the styloid process, and the hyoid 
bone. 

The remaining arches assist in forming the structures of the neck. 

Describe the eyeball and give its parts. 

The eyeball is almost spherical in shape; it is perforated by the optic 
and ciliary nerves and the ciliary and central artery of the retina. At 
the junction of the anterior and posterior segments the globe is pierced 
by the anterior ciliary artery. The eyeball is composed of two spheres, 
an anterior, transparent, corneal segment, and a posterior, opaque, scleral 
portion, the union of the two parts being indicated externally by a slight 
groove, the sulcus sclera. The central points of the anterior and posterior 
curvatures constitute respectively the anterior and posterior poles. The 
sagittal and transverse diameters are nearly equal, usually about 24 mm. ; 
the vertical diameter is about 23.5 mm. The eyeball consists of three 
concentric tunics, contained within which are three transparent refracting 
media. The three tunics are: (1) an outer fibrous coat, the sclerocornea, 
consisting of an opaque posterior part, the sclera, and a transparent ante- 
rior portion, the cornea; (2) an intermediate vascular, pigmented, and 
partly muscular tunic, the tunica vasculosa oculi, comprising from behind 
forward the choroid, the ciliary body, and the iris; (3) an internal nervous 
tunic, the retina. The three refracting media are named from before 
backward; the cornea, aqueous humor and crystalline lens. 

Describe the crystalline lens and state what tissues are in 
contact with it and how. 

The lens is a transparent biconvex body, more convex posteriorly than 
anteriorly. It is enclosed in a capsule and consists of lens fibers derived 
from epithelial cells (ectoderm), arranged in layers, which are softer in 
consistency near the surface {cortex), and more compact at the center 
(nucleus). It is nonvascular in the adult; the hyaloid artery supplies it in 
the fetus. The lens is lodged in a depression in the vitreous, where it is 
retained by the suspensory ligament attached to the ciliary body. The 
iris rests upon its anterior surface, the ciliary processes laterally. 

Describe the lacrimal apparatus. 

The lacrimal gland, which secretes the tears, is lodged in a depression 
at the outer and upper angle of the orbit; it pours the tears on the con- 
junctiva at the outer angle of the lids. The tears pass over the eyeball 
and enter the puncta lachrymalia, which are situated on the lacrimal 
papilla, on the inner end of the lids at the outer extremity of the locus 
lachrymalis; from the puncta the tears pass through the superior and infe- 
rior canals to the lacrimal sac. The lacrimal sac is lodged in a deep groove 
formed by the lacrimal and superior maxillary bones. The sac empties 
into the nasal duct, which is a membranous canal about 3/4 in. in length; 
it in turn empties into the inferior meatus of the nose. The opening into the 
nose is guarded by the valve of Hasner. 

Describe the Eustachian tubes. 

They are two tubes about 1 1/2 in. long, passing downward, forward, 
and inward from the middle ear to the nasopharynx. They consist of one- 



I MB1Y01 

third bone ;mil two third, nbrocartj • • lined b? rfllstH 

epithelium I be pharyngeal orifice is usuallj .1 irertl ituated In 

the lateral wall of the nasal pharynx. 

(ii\c the location ami describe the anatomic structure ol the 
kidnc\s. 

The kidneys are Situated in the lumbar region and rest upon ihcjM..i, 
US and quadratUfl lumhorum muscles. The u|)pcr end of the 1« ' 

kidney reaches as high as the upper border of tin- eleventh rib, tin* upper 
end oi the right as high as the lower border ol the eleventh rib. Each is 
capped by % suprarenal body. The kidney is surrounded byacopsuk 
a perirenal connective tissue containing fat; it is supplied by the 

artery ami drained by the renal vein and Lmyphatics. The I 
derived from the renal plexus of the sympathetic system. 

The kidney is l>ean shaped, the QOtl fa upon the inner border is ( .die I 
the ktium, and leads into a depression or cavity known as the sinu 
In the sinus the ureter begins and tin- vessels and nerves enter or I 

The interior oi the gland consists of a connective tissue, parenchyma 

Supporting vessels, and uriniferous tubules. It is subdivided into the 

. and the medulla. The cortex contains the glomeruli (cofl< 
blood-vessels) and some of the tubules; the medulla consists of pyramids 
(Malphighian or medullary made up of parallel collecting tubules, 
which terminate upon the apex of the pyramid and pour the urine into 
the calices of the pelvis of the kidney. The uriniferous tubules begin 
around a glomerulus as a closed extremity {capsule of Bowma?i), and pass 
tortuously through the cortex {loop of llenle), terminating in one of the 
collecting tubules found in the pyramid of Ferrein. 

Describe the arteries and veins passing to and from the 
kidneys. 

Arteries: The renal arteries are given off from the abdominal aorta 
immediately below the superior mesenteric; the right is longer than the 
left and passes behind the inferior cava. Each artery divides into four 
or five branches before entering the hilum. 

Veins: The renal veins pass out of the hilum and empty into the 
inferior cava. The left, longer than its fellow, passes in front of the 
aorta and receives the left spermatic vein. 

EMBRYOLOGY 

What is embryology? 

It is the study of the development of the embryo. 

(a) Distinguish between embryonic and fetal; (b) during 
which period is the dental ridge formed? 

The fifth week marks the completion of the period of development 
during which the product of conception has acquired the characteristic 
features of its embryonal stage. Beginning with the second month and 
continuing until the close of gestation, the succeeding stage of the /W/*s is 
distinguished by the gradual assumption of the external features which 
are peculiar to the young human form, (b) During the embryonic. 
9 



130 ANATOMY 

Name the lowest form of animal life, (b) What is proto= 
plasm, (c) What is morphology? 

(a) Ameba. (b) Protoplasm is the substance of a cell, (c) The study 
of the form of organisms. 

What is histology? 

The study of minute structure of normal tissue. 

Give the principal tissues of the animal body. 

Epithelial, connective, muscular, and nervous. 

What is the blastoderm? 

It is a cavity surrounded by embryonal cells formed from the morula. 
It consists of three layers; ecto- meso- and entoderm. 

What is protoplasm? 

It is the substance that makes up the cell and is divided into spongio- 
plasm and hyaloplasm. 

Mention the structures contained in a cell. 

A cell is a nucleated mass of protoplasm. It is made up of a cell 
wall, the cytoplasm, nuclear membrane, nucleus and nucleolus. 

What is the nucleus of a cell? 

It is a round or oval body usually situated in the center of the cell. 
It consists of two parts, the chromatin and the achromatin or nuclear 
matrix. The chromatin has an especial affinity for anilin dyes. The 
nucleus frequently contains a small body, the nucleolus, and is surrounded 
by a limiting membrane. 

Describe the process of cell reproduction. 

Cells reproduce by karyokinesis (mitosis) which is divided into four 
stages: (1) prophase or preparatory stage; (2) metaphase, during which 
the chromatin of the cell is equally divided; (3) anaphase, the migration 
and rearrangement of the chromatin in the two new nuclei; (4) telophase, 
during which the cytoplasm undergoes division and the daughter cells 
are completed. 

What is spongioplasm? 

The network of the cytoplasm which supports the gelatinous portion 
of the cell. 

What tissues of the oral cavity are formed from the ecto- 
blast? (b) From the mesoblast? 

(a) The epithelium of the mouth, including its salivary and other 
glands, the enamel-organ, and the nerves, (b) The tunica propria of 
the mucous membrane, the blood-vessels and lymphatics and the dentin. 

From what layer of the embryo is the vascular system 
developed? 

Mesoderm. 



in ODKRMK LAY! 

What tissues are derived from the iiumhIitiii? 

The imiiin tivc tissues including areola! tissue, tendon, card! 
bone, dentin of tin- teeth, the musculai aim and lym 

phatic systems Including their endothelium and diculndi 1 Km 

.sexual pands and their excret< the termination of 

the ejaculatory ducti and vagina, the kidneyi and nn 

PrOfD what is the mcsoblast derived? 

From entoderm and ectoderm. 

\\ hat tissues are derived from the entoderm? 
The epithelium of the digestive tract, and glandular append.'. 
excepting the anal eanal and mouth, epithelium oi the respiratory tra(t, 

bladder, urethra, thyroid and thymus bodies. 

What tissues are derived from the ectoderm? 

'The epithelium of the outer Burface of the body, the epithelium of the 

nasal tract and the cavities Communicating therewith, the epithelium of 
the mouth and salivary glands, enamel of the teeth, the tissues of the 
nervous system, the retina, lens and vitreous, the epithelium of the pituitary 
and pineal bodies. 

What Iavers of the embryo contribute to the development of 
the teeth? 

The ectoderm supplies pericementum and enamel, while cementum, 
dentine, and pulp are derived from the mesoderm. 

What tissues of the teeth are developed from the connective- 
tissue group? 

Dentin, cementum, pulp. 

What is the primitive dental groove? (b) What organ of 
the teeth is developed from it? 

A longitudinal groove seen on the surface of the oral ectoderm which 
marks the point of attachment of the dental ridge, (b) Enamel organ. 

Describe the dental ridge. 

It is a thickening of the primitive oral epithelium over the alveolar 
margin from which the enamel germ is later developed. 

Describe the development of the dental papilla. 

This structure is a condensation of the mesoderm beneath the epithelial 
outgrowth and appears shortly after the club-shaped enamel organ begins 
to expand. At first it consists of a close aggregation of small round pro- 
liferating cells, but later becomes elongated and arranged as a continuous 
row of cylindrical cells which cover the apical papilla and lie beneath 
the enamel -organ. These cells are the odontoblastic or dentin-producing 
cells. 

What two tissues are formed by the dental papilla? 

Dentin and pulp. 



132 ANATOMY 

Why should there be a difference between the structure of 
dentin and cementum? 

Dentin is derived from the mesoderm by means of the specialized 
cell, the odontoblast. Cementum is also of mesodermic origin, but 
constructed from the alveolar periosteum by the cementoblast, therefore 
it resembles bone. 

Describe the development of cartilage. 

The development of cartilage proceeds from the mesoblast, the cells 
of which undergo proliferation and form compact groups which later 
become the embryonal cartilage cells. 

Cartilage grows in two ways (a) by the expansion produced by the 
interstitial growths effected by the formation of new cells and the associ- 
ated matrix, and (b) by the addition of the new tissue developed from 
the perichondrium. The latter mode continues through the period of 
growth. 

Describe Meckel's cartilage. 

A rod of cartilage which appears in the mandibular arch and assists 
in the formation of the inferior maxilla, malleus, and incus bones. It 
disappears at about the sixth fetal month. 

Describe a method of preparing tissues for microscopic 
sections. 

The tissues to be examined should be removed as freshly as possible 
and cut into pieces not more than 2 cm. in thickness, and placed in a 
"fixative" such as Muller's fluid, which is changed as soon as it becomes 
cloudy. They should remain for about two weeks in Muller's fluid. 
Wash in running water for twenty-four hours to remove the Muller's 
fluid. The tissues are next hardened in alcohol, beginning at 80 per cent., 
then 95, and finally absolute alcohol. Allow the tissue to remain in each 
twenty-four hours. The tissue is now ready for infiltration with celloidin 
or paraffin. Place the tissue in a solvent of the substance used for 
infiltration. If celloidin, place in equal parts of alcohol and ether for 
twenty-four hours; then in a solution of thin celloidin for twenty-four 
hours and follow this by thick celloidin for twelve hours. It is now 
mounted on a block by surrounding the tissue and block with a layer of 
thick celloidin which hardens when exposed to the air. The block and 
tissue should be placed in 80 per cent, alcohol until ready for cutting. 

Describe the method of cutting tissue for microscopic section. 

The tissue is embedded in celloidin or in paraffin and mounted on cubes 
of wood or a special composition forming the tissue blocks. Sections 
may be cut with a razor ground flat on one side, but usually a micro- 
tome is employed. For celloidin sections, the knife is fixed obliquely so 
that a long stroke may be made; the tissue block is held in a clamp and 
moistened with 80 per cent, alcohol; the knife is drawn rather rapidly 
across the block several times until a smooth section is obtained; the 
section is then removed and immersed in water until ready for mounting 
upon slides. For paraffin blocks the knife is set at right angles to the sec- 
tion; the sections are cut dry and removed at once to a slide with a camel's 
hair brush. 



i i ; . 1 1 ELIU U 

\\ ii.-it is epithelium? 

It is an elementary tittilC derived fr<>m r. tndrrm 01 entoderm which 

coven all surface! that communicate with the air. 

Mention the \arietics of epithelium. 

Squamous (a) Simple, 
(b) Stratified. 

I olurnnar (a) Simple. 

(I») Stratified. 

Modified (a) Ciliated 
(b) Goblet 

u ) Pigmented. 

Specialized (a) Glandular epithelium. 
i !») Neuro-epithelium. 

How docs a mucous membrane differ from a serous mem- 
brane? 

A mucous membrane consists of layers of epithelium resting upon 
.1 connective-tissue base, the tunica propria. The epithelium extends 
down to the connective-tissue base to form the mucous glands. All 
cavities that communicate directly or indirectly with the atmosphere are 
lined with mucous membrane. 

Serous membranes are found lining closed sacs (pleura, pericardium, 
joint cavities, etc.). They consist of a single layer of endothelial cells 
resting upon a basement membrane. Minute openings called stomata, 
existing between the cells, communicate with the lymph capillaries. 

Describe the microscopic appearance of columnar epithelium. 

Columnar epithelium may be simple or stratified (in layers). The 
cells are cylindrical. The oval nucleus is situated at the base, which 
rests on end upon the basement membrane. When several layers are 
present, the superficial layer only presents the columnar type, the deeper 
cells being irregularly columnar or polyhedral. 

What form of epithelium lines the oral cavity? From what 
elementary tissue is it developed? 

Stratified squamous. It is developed from the ectoderm. 

Describe the structure of the mucous membrane lining the 
oral cavity. 

It comprises two distinct parts; the epithelium (stratified squamous), 
which forms the free surface and protects the delicate subjacent structure; 
and the tunica propria, a connective-tissue stroma which gives place and 
support to the blood-vessels, nerves and lymphatics. 

Of what is each of the following composed? (a) the hair; 
(b) the nails; (c) the enamel of the teeth? 

(a) The hair is a modified epithelium, (b) The nails are highly 
developed parts of the stratum lucidum of the epidermis, (c) The enamel 
is developed from an invagination of the ectoderm. 



134 ANATOMY 

Describe the microscopical appearance of adipose tissue. 

The fat cells appear as large, clear, spherical sacs, held together 
by delicate areolar tissue. Unless treated with some stain possessing 
an especial affinity for fat, as osmic acid, the oily content of the cells 
appears transparent, colorless and seemingly occupies the entire cell-body. 
Critical examination demonstrates the presence of an extremely thin 
peripheral layer of cytoplasm completely surrounding the oil drops and, 
at one place, a compressed nucleus. 

Describe the structures of arteries. 

The arteries are composed of three coats or tunics. The inner or 
intitna consists of an endothelial lining resting upon a layer of loose con- 
nective tissue which is separated from the middle coat by a layer of elastic 
tissue. The middle or muscular layer or media consists of involuntary 
(nonstriated) circular muscle fibers. The outer coat or adventitia 
consists of white fibrous and yellow elastic connective tissue. The 
nutrient blood-vessels (vasa vasorum) are contained in the outer tunic. 

What is the structure of capillaries? 

Ultimate radicals of the arterial system consisting of a single layer 
of endothelial cells united by intercellular cement substance. 

What is periosteum? 

The external surface of bones is closely invested, except when covered 
with cartilage, by a fibrous membrane, the periosteum, a structure of 
great importance during development and growth and later for the nutri- 
tion and repair of the osseous tissues. The adult periosteum consists 
of two layers, an outer fibrous, and an inner fibro-elastic; during growth 
an additional layer, the osteogenetic layer is present. 

Describe the centers of ossification. 

In the development of bone, certain places in each primitive bone 
show changes from cartilage into bone. Here the cartilage cells arrange 
themselves in rows, then are absorbed, and their place is taken by osteo- 
blasts. Deposition of calcareous substances later takes place and sup- 
plies the characteristic hardness of bone. 

Describe the perforating fibers of Sharpey. 

They are bundles of fibrous tissue which penetrate the outer cir- 
cumferential lamellae in a direction perpendicular or oblique to the surface, 
and pin the layers together. They are developed from the periosteum. 
They are never found in the lamellae constituting the Haversian systems. 

What is calcification? 

It is the process by which tissue becomes infiltrated with lime salts. 

Describe osteoblast, osteoclast. 

An osteoblast is derived from the periosteum and assists in the calcifi- 
cation of bone. An osteoclast is a variety of leucocyte which absorbes 
the calcified substance of bone. 



wnei nvi 

Describe the* process h\ which osteoblasts arc converted into 
hone cells. 

I ' itftoMeati axe derived iiom the periosteum and take the pla< «• of the 

cartilage cells In boilC formation During the pro. .ideation, 

some of than ere Burrounded by * el< ereou i DcuUenn] end form bone i elle. 
They occupy ■ lacuna In tin- bone, 

\\ hat are lacim.c? 

They are spei ee in compact connective tissue, su< b as bone and ( arti- 
Lage. They rraititn bone or cartilage cells. 

N une three varieties of cartilage and describe one. 

Hyaline, yellow elastic and abrocartilage. 

Rbrocartfiage is found in few localities such as the Intervertebral 
and interarticulai disks. It is flexible and tough. En structure, it 
lesemblea dense fibrous connective tissue, since the principal constituent! 

of its matrix arc the wavy bundles of closely packed white fibers. Be- 
tween these bundles lie small, irregularly distributed oval areas of hyaline 
matrix, which immediately surround the cartilage cells. A distinct 
perichondrium is wanting. 

Describe the intercellular constituents of connective tissue. 

During the period of embryonal growth, the intercellular substance 
is semifluid, a little later it is still soft, while, as the adult tissue, it be- 
comes tough. Grouped as masses in which fibrous tissue predominates, 
the intercellular substance acquires the toughness and inextensibility of 
tendon; where, on the contrary, large quantities of elastic tissue are present, 
as in certain ligaments, extensibility is conspicuous. Where the ground 
substance becomes impregnated with calcareous salts, the hardness of 
bane or of dentin results. Notwithstanding these variations in the density 
and physical properties of the intercellular substance, the cellular ele- 
ments have undergone little radical change, the connective tissue-corpus- 
cles, the tendon-cell, the cartilage-cell, and the bone corpuscle being 
essentially identical. 

What is connective tissue? 

It is of mesodermic origin and is composed of cells and intercellular 
substance, the latter being in excess of the cellular elements. Connective- 
tissue cells are round, spindle-shaped, stellate and fusiform. It is the 
most widely distributed tissue in the body. 

What is the function of connective tissue? 

It is the great supportive structure of the body, also the means of con- 
veying fluids, etc., from one part of the body to another, e. g., blood- 
vessels. 

Describe the stratum Malpighii. 

The cuticle or true skin consists of two chief layers, the deeper or 
stratum Malpighii, and the superficial or stratum corneum. The stratum 
Malpighii is of the stratified squamous type with the deeper cells becoming 
columnar. 



136 ANATOMY 

What tissue binds together the voluntary muscle fibers? 

The cells are held in small primary bundles by endomysium. These 
are collected into larger bundles surrounded by perimysium, and finally 
into the muscle, which is covered by epimysium. 

What is the sarcolemma? 

A delicate sheath of connective tissue covering the striated, voluntary 
muscle fibers. 

Describe a ganglion. 

The cell bodies of the neurones that constitute the sensory pathway 
within the peripheral nerves and of the neurones of the sympathetic 
systems are collected at various points into aggregations known as ganglia. 

How do nerve fibers terminate? 

As a nerve reaches its termination it loses its medullary sheath, the 
neurilemma, and finally the axis-cylinder breaks up into fibrillar, which 
terminate as free endings. 

Sensory nerves terminate in end-bulbs, as in the tactile corpuscles 
{corpuscles of Meissner). When the motor nerve fiber reaches the muscle 
fiber which it supplies, its medullary coat ends, the neurilemma becomes 
fused with the sarcolemma of the muscle fiber, while the axis-cylinder 
passes beneath the sarcolemma to terminate in an end-plate. 

Describe the axis=cylinder, the medullary substance, the 
neurilemma. 

The fundamental part of every nerve fiber is the central cord, known 
as the axis-cylinder, which is composed of delicate threads, the axis- 
fibrillae, prolonged from the nerve cell and embedded within a semifluid 
interfibrillar substance, the neuroplasm. In the case of the typical fibers, 
as in the peripheral nerves, the axis-cylinder is surrounded by a relatively 
thick coat, known as the medullary sheath. Outside of this is the neu- 
rilemma. The medullary substance is not continuous, being interrupted 
at points called the ''nodes of Ranvier." 

Describe a nonmedullated nerve fiber. 

These fibers are devoid of the myelin sheath throughout their course. 
They are chiefly the axons of sympathetic neurones, and consist of only 
the axis-cylinder and the neurilemma, the latter being thin and delicate. 

Describe the neuroblasts. 

The neuroblasts are derivatives of indifferent connective-tissue cells 
and are directly converted into the neurones. 

Where are nerve cells found? Describe their structure and 
functions. 

Nerve cells are present in the cerebrum, cerebellum, spinal cord, and 
posterior root ganglia. A nerve cell consists of a large nucleus, a cell 
body, an axon, and numerous dendritic processes. They are classified 
according to the number of poles (axis-cylinders), as unipolar, bipolar 
and multipolar. 



mi 111 in 

Describe a transverse section of a r< »< >t of a tooth as seen 
ninler the microscope. 

[n the center of t he root wQl be seen a whit th< pulp < kom 

Burrounding this is the dentin, arranged in radiating li do the 

chamber out. Out-Mr oi t ho dentin is .1 thin layer, th< on. 

Describe the blOOd Supply to ttlC tooth pulp and pericemen- 
tum. 

The arterial twi^s from the inferior dental alveolar or infra-orbital 
arteries enter the pulp canal through the apical foramen and break up 
into i fine capillary plexus. From the same arteries an- developed capil- 
lary networks in the pericementum. 

\\ here does calcification of a tooth begin? 

In the enamel it begins nearest the papilla; in the dentin, at the 

periphery oi the papilla. 

What is the peridental membrane? 

It is a fibrous tissue investment which covers the root of the tooth. 
It is derived from the outer layer of the dental sac. This membrane serves 
to hold the tooth in its socket, and acts as a cushion to diminish shock 
during mastication. 

Describe Nasmythe's membrane. 

The enamel cuticle is a delicate envelope that completely invests the 
crown of the newly erupted tooth. It rapidly disappears from the areas 
exposed to wear, but over the protected surfaces it may persist through- 
out life. The membrane is transparent, structureless, resistent to acids 
less so to alkalies. It is the remains of the enamel organ. 

What are ameloblasts? 

They are the enamel-producing cells and are derived from the enamel 
organ. 

What are the striae of Retzius? 

They are brownish parallel lines in the enamel, which correspond in 
their general direction with the contour of the tooth, but run at an angle 
of from 15 to 30 degrees with the free surface. In cross sections these 
stripes are represented by a series of concentric lines encircling the 
crown, parallel to and near the surface; in the middle and deeper parts 
they are less evident or entirely wanting. 

Where are the lines of Schreger found? (b) Salter? 

The adjacent enamel prisms are in general parallel to one another. 
They extend across the tooth in an undulating manner, thus giving rise to 
certain radial striations seen by reflected light (Schreger' s lines). These 
markings must not be confounded, however, with another set of stria?, 
the contour lines of Owen or the incremental lines of Salter, which are 
best seen in the crown, running obliquely to the surface of the dentin, and 
depend probably upon variations in calcification incident to the growth 
of the dentin. 



I38 ANATOMY 

What is the principal chemical element in (a) enamel and 
(b) dentin. 

(a) Phosphate of calcium, 89.82 per cent.; carbonate of calcium, 
4.37 per cent.; magnesium phosphate, 1.34 per cent.; a trace of calcium 
fluorid; other salts, 0.88 per cent, (b) Calcium phosphate, 66.72 per 
cent.; calcium carbonate, 3.36 per cent.; magnesium phosphate, 1.08 
per cent. ; calcium fluorid, trace. 

Give analysis of dentin, cementum, and enamel. 

Dentin contains 72 per cent, of earthy matter and 28 per cent, of or- 
ganic substance. Cementum contains 69 per cent, earthy matter and 3 1 
per cent, organic matter. Enamel contains 97 per cent, earthy matter and 
3 per cent, organic matter. 

Name the three organs which affect the calcification of the 
tooth. 

Ameloblasts in the enamel, odontoblasts in the dentin, cementoblasts 
in the alveolar periosteum. 

What cells form dentin? 

Odontoblasts. 

» 

Describe an odontoblast. 

Tall columnar cells, situated vertically to the surface of the pulp. 
They send out long processes, the dentinal fibers, into the dentinal tubules 
and short ones into the pulp tissue. They produce dentin. 

With what do the dentinal fibers connect? 

Odontoblasts. 

How is secondary dentin formed? 

By the odontoblasts being stimulated by irritation of the pulp. It is 
usually caused by caries. 

What is the purpose of secondary dentin? How does it differ 
from true dentin? 

When it is formed in carious teeth, it seems to supply the loss sustained 
by the weakening of the wall. It is frequently found in the teeth of old 
persons. Secondary dentin differs from true dentin by its irregular and 
imperfect calcification. It is also known as osteo-dentin. 

What are the interglobular spaces? 

The junction of the dentin and cementum is always marked by a zone 
of closely placed interglobular spaces of small size. Under low power 
these spaces appear as dark granules. 

What is meant by the matrix in full developed dentin? 

It is the substance that holds the dentinal tubules together. It is 
composed of bundles of extremely delicate fibrous fibrillae. The dis- 
position of the bundles of fibrillae is chiefly longitudinal and parallel 
to the surface. The fibrillae are knit together by the calcified ground 
substance. 



tin-: 1 1 1 in 

Describe the dental fibril!**. 

I hey air pnue^es prolnni/rd ir.mi the odontoblasts which till th<- 
dentinal tubule-. 

Describe the development and formation <>i dentin. 
Dentin ifl developed bom the dental papilla, which u derived from 
mesoderm. The mesoderm a i upies the cup- ihtped i a\ ity formed by the 

enamel. 

Describe the dentinal tuhuli. 

Dentin consists of a highly calcified matrix which u itself practically 
structureless, although everywhere traversed by tubes (the dentinal 
tubules), which give to thi^ tissue a finely striated appearance, the stria- 
usually running in wavy lines. Tlu- tubes begin by open mouths on the 
wall oi the pulp cavity, whence they run an undulating course toward the 

periphery 01 the dentin. The tube- are lined with .special gheathfl -heath 
of Neumann). 

What are the fibers of Tomes? 

Branching processes of the odontoblasts in the dentinal canals. 

What is Neumann's sheath? 

The immediate wall of the dentinal tubules is formed by a delicate 
membrane, the sheath of Neumann, which, in transverse sections appears 
as concentric rings. 

Is dentin developed inwardly or outwardly? 

It develops from without in, toward the papilla. 

What would be the result of exposing dentin to the action 
of a strong acid for several days? 

The earthy substances would be destroyed and a soft gelatinous 
substance remain. 

What is the origin of cementum? 

It is derived from the alveolar periosteum. 

Where does cementum form the thickest? 

At the apex of the root of the tooth. 

Describe the contents of the central chamber in a tooth. 

The central (pulp) chamber of a tooth contains the pulp — a system of 
arteries, veins, and nerves held together by a framework of connective 
tissue. The pulp has protoplasmic extensions in the tubuli of the dentin 
consisting of nervous tissue. 

(a) What are the anatomical divisions of a tooth? (b) 
What are the structural differences? 

(a) The anatomical divisions are the crown, neck, and roots. The 
crown is composed of dentin covered with enamel, thickest over the cusp, 
becoming gradually thinner till it tapers off at the neck, slightly over- 



140 ANATOMY 

lapping the cementum, which covers the dentin of the roots as the 
enamel covers the crown. 

From what sources do the different structures of a tooth 
receive their nourishment? 

The enamel and dentin from the pulp. The cementum, from the 
peridental membrane. 

Describe the structure, blood supply, and nerves of the pulp. 

It consists of embryonic connective tissue, which is composed of stel- 
late cells with a transparent matrix. An artery enters the apical fora- 
men and breaks up into a fine capillary network. The nerves enter 
through the apical foramen and pass into and through the pulp to the 
dentin. 

How, and from what source does a tooth receive its blood 
supply? 

The teeth are supplied by the pulp and pericemental membrane. 
They receive the blood from the inferior dental, alveolar, and infra-orbital 
arteries. 

Describe the manner of the tooth attachment, naming tissues. 

The roots of the teeth fit loosely into sockets in the alveolus and are 
attached to the bone by rough fibrous bands running from the 
periosteum to the pericementum. 

What is the function of the peridental membrane and how 
does it receive its blood supply? 

To hold the tooth in place, give sense of touch to the teeth, act as a 
cushion between the tooth and the bone, nourish the tooth when the pulp 
is devitalized, and nourish the cementum. It receives its blood supply 
from the apical artery before it enters the tooth. 

Describe the alveolo-dental membrane. 

The root of the membrane forms a layer of connective tissue free from 
elastic fibers, which fixes the root of the tooth in the alveolus, being 
firmly united by perforating fibers of Sharpey to the crusta petrosa on 
the one hand, and to the bone on the other. Its blood supply is derived 
from the apical artery. 

Describe the ossification of the alveolar process. 

During fetal life the process presents a longitudinal furrow which 
corresponds to the future tooth-sockets and contains the developing teeth. 
Later, the process develops a prolongation around each tooth. These 
are absorbed when the roots of the temporary teeth are shed. For the 
permanent teeth, the same changes occur. 

What is meant by succedaneous teeth? (b) At what ages do 
they erupt. 

Succedaneous teeth are those which in rare instances erupt after the 
loss of the permanent set. They erupt, if at all, only in persons of ad- 
vanced age. 



! Ill 1 1 I III 1)1 

Define lymphatic* to lymphatics round In the teeth? 

They are exceedingl) delicate vt «i . thai take u;» the <\. ,-,. <>i tin ids 
and return them to toe blood urcam. I h<\ the ciretiun-, 

of the lymphatic glands t>> the t > l « >* >« l . 

\ o lymphatics have been demonstrated in the teeth. 

w hich of the permanent teeth arc the- tir-st to calcify? 
Tin- upper first molars oi ib yeai molai 

\t what age arc the roots of the six anterior superior teeth 

fulls developed, 

About the fourteenth year. 

Name and describe the surface of the first superior molar. 

The buccal and palatal surfaces are convex and have each a fissure 
extending two-thirds of the distance to the gingival margin. The n 
and distal surfaces are but slightly convex, and present a depre 
and at the gingiva] margin. 

Describe the occlusal surface of lower first molar including 
grooves and cusps. 

The occlusal surface is cubical in form, rounded at the corners, 
length greater than breadth; there are usually five cusps (three b 
and two lingual) with a groove between cusps, and a central gi 
between lingual and buccal groups. This latter groove is forked mesially 
and distally. 

The occlusal surface presents two buccal and two palatal cusps with 
a transverse and longitudinal iissure separating the cusps. 

Name the surfaces of an upper first molar. 

Buccal, palatal, mesio-approximal, disto-approximal, and occlusal 
surfaces. 

Give the points of distinction between the crowns of a 
typical lower first and a lower second bicuspid. 

The first bicuspids are larger, the buccal cusp prominent, and the 
lingual cusp small and much lower than the buccal; while the second 
bicuspid is smaller, with flatter surface and cusps of nearly the same 
height and size, buccally and lingually. 

State the points of distinction between the upper first and 
second bicuspids. 

The principal points are the greater length of the first bicuspids and 
the fact that usually the tirst bicuspid has a bifurcated root and, there- 
fore, two canals; while the second bicuspid usually has only one canal. 

Describe the pulp chamber of an upper central incisor. 

The outlines of the pulp chamber follow the outlines of the tooth. 
There is one root canal, slightly flattened mesiodistally. The pulp 
chamber usually extends over about one-third of the crown, but in old 
people the entire crown portion may be obliterated by the formation of 
secondary dentin. 



I42 ANATOMY 

What is the long axis of a tooth? (b) What is meant by 
the term inclination when applied to the teeth? 

A line drawn through the crown to the apex of the root would repre- 
sent the long axis of the tooth. By inclination, we mean the direction 
of the slant of the long axis of each tooth. The incisors incline labially 
and mesially, the canines mesially; the bicuspids are nearly perpendicular, 
but incline buccally in the upper, and lingually in the lower; the molars 
tend to incline distally and buccally in the upper jaw, and mesially and 
lingually in the lower jaw. The compensating curve, starting with the 
central incisor cusps, is represented by a line drawn along the apices 
of the cusps, descending to the cuspids; thence passing horizontally over 
the bicuspids, and gradually ascending as each molar is passed. 

Describe the lingual surface of the upper incisors, naming 
the distinctive features. 

The lingual surfaces of the incisors are concave, presenting, as a rule, 
three longitudinal ridges and two grooves with one, or sometimes two 
prominences near the gingival border or basal ridge. The ridge is 
prominent and curves sharply under the gum line to meet the perpen- 
dicular of the root. 

Describe permanent cuspids, (b) Why is their retention 
important? 

The permanent cuspids are situated directly back of the lateral 
incisors in each jaw. The crown is large and convex labially, with a 
marked cusp or pointed incisal edge. The lingual surface is slightly 
concave, with prominent ridge and a median ridge extending from cusp 
to gingiva. The root is long and conical, slightly compressed mesially and 
distally. Their retention is important to preserve the canine eminence 
and prevent the falling in of the face at that point. They are the longest 
and strongest teeth in the arch, being known as the keystones of the arch. 
They fix and, to a great extent, maintain the proper relations of the two 
arches. 

Describe pulp chamber of superior first bicuspid. 

The outline of the pulp chamber follows in general the outline of the 
tooth itself; the canals are usually fused into one flattened canal. 

Give the reasons for the necessity of an accurate knowledge 
of the pulp cavities. 

A knowledge of the approximate size and shape of the various pulp 
cavities is necessary to avoid exposure of the pulp while evacuating and 
grinding teeth for the reception of caps, and to insure entire and perfect 
removal of tissue after devitalization. 

Why is it important to know the periods of delevopment of 
the roots of the permanent teeth? 

This knowledge is important when devitalizing nerves, filling the 
canals of the roots, and in orthodontic work. Special care must be taken 
owing to the enlarged apical foramen in roots not fully developed. 



Di trrmoM 

(ii\c the usual number of root canals in c.u h of the per- 
manent teeth, b) I" Nvhat teeth arc \ ari.it ions I i k c I \ t«. be 
found. 

Centrals, Literals, cuspids an. i upper first bicuspids sad lower l>i- 

CUSpids, ciu- canal; the upper second bicuspid, two tanal.s; the upper 

molars, three i snals; and the lower molars, two flattened or four di.stin< t 
canals, Variations an- most likely in the lower moJ • r ii><-« l) and 

in the blCUSpids, where we .sometime^ find two lan.ih, in the low 

bicuspid and sometimes two canals in the uj>j>er hrst bicuspid. 

What teeth Bhotlld he normally present in the month ot a 
child of twenty months? 

POUT lower, and four Upper inci.sors; four canine-, and four first 
molars. 

At what ages are the temporary and permanent teeth erupted? 
Eruption oi milk teeth: 

Six to dght months Two middle and lower incisors. 

Eigh to ten months Four upper incisors. 

Twelve to fourteen months Two lateral lower incisors and four 

first molars. 

Eighteen to twenty months Four canines. 

Twenty-eight to thirty-two months. Four second molars. 
Eruption of permanent teeth: 

Sil years Four first molars. 

Seven years Four middle incisors. 

Eight years Four lateral incisors. 

Nine years Four first bicuspids. 

Ten years Four second bicuspids. 

Eleven years Four canines. 

Twelve years Four second molars. 

Seventeen to twenty-five years Four wisdom teeth. 



PHYSIOLOGY 



THE BLOOD 

Describe the physical appearance and characteristics of the 
blood. Compare arterial with venous blood. 

The color varies from bright red in the arteries to dark blue in the 
veins. It is an alkaline liquid with a salty taste, a characteristic odor, 
and a specific gravity of about 1055. When exposed to the air or brought 
in contact with a foreign body, blood coagulates. Arterial blood is a 
brighter red, contains more oxygen and less carbon dioxid, and coagulates 
more readily than venous blood. 

Name some of the bodily states which lessen the alkalinity 
of the blood. 

(a) Exercise, which is attended by the development of acid in the 
muscles; (b) digestion, when the diet contains an excess of proteids or is 
deficient in alkaline mineral salts; (c) lactation; (d) rheumatism, gout, 
and the acid intoxication of diabetes. 

Why does blood remain fluid in the body in life, and coagulate 
when shed? 

Because blood does not undergo coagulation while it is in immediate 
contact with the living and unaltered vessel wall. In shed blood the 
disintegration of the white corpuscles liberates the fibrin ferment, or 
thrombin, and clotting takes place. 

What is the normal proportion of blood in the human body, 
and how is it renewed after hemorrhage? 

In the adult the blood is equal to one-thirteenth of the body- weight; in 
the new-born about one-nineteenth. The liquid portions of the blood 
are renewed from the ingested food and liquids; the corpuscles from the 
bone marrow, spleen, and lymphatic tissues. 

Give the amount of blood, in pounds, in the body of a person 
weighing one hundred and forty=three pounds. 

Eleven pounds. 

Describe the process of coagulation of the blood. 

Coagulation is a fermentative process that consists in the transforma- 
tion of the soluble albumin of the plasma or fibrinogen into the solid sub- 
stances of the fibrin, through the action of an enzyme which is called 
fibrin ferment or thrombin. Both fibrinogen and fibrin ferment are formed 
by the disintegration of white blood-cells. The fibin forms a meshwork 

144 



Till 111 

of threads in whii h the blood co 

tin- i lot 01 ". whii h at on< c b 

What conditions retard, suspend, or |>rc\cnl the CMgUfaUiOII 

of blood? 

utad with ■ living ressd wall ; cold (o C); the addition of alkalies, 
ammonia, concentrated solutions of neutral salts of alkalies and earths, 
peptone; the addition of oxalii add (b) precipitating the caldua 
addition of egg albumin, sugar .solution, glycerin, and 
with i foreign substance to which the blood cannot adhere, as, for ir^ • 

oily Objects; the disease known as hemophilia. 

(ii\c the Composition, reaction, and uses of blood. 

L'omposition: Blood is composed of scrum, or plasma, and corpusi let 
in the proportion of DO to 40. The solid matter consists of proteids, 
lerum albumin, scrum globulin, fibrinogen, and various salts; compounds 

o\ sodium, calcium, potassium, and magnesium in combination with 
chlorin, phosphorus, and carbon diozid. Other Bubstances contained 

in the blood are fats, urea, uric add, dextrose, and cholesterin. 

The blood is alkaline in reaction from the presence of disodium phos- 
phate. 

The function of the blood is to carry oxygen and nutriment to the tissues 
and to convey waste material to the excretory organs. It also assists 
in maintaining a uniform body temperature. 

(a) State the average specific gravity of the blood ; (b) state 
some causes of variation in specific gravity. 

(a) About 1055. (b) The specific gravity is increased after hemor- 
rhage; in diabetes, owing to the quantity of glucose in solution in the blood; 
in congestive states; during digestion; in diarrhea (cholera morbus, Asiatic 
cholera) ; and during profuse sweating. Ths specific gravity is diminished 
in the anemias; temporarily after the copious ingestion of food; in dropsy 
and general anasarca; and after ligation of the ureters. 

Describe the red blood=corpusc!es as to (a) origin and fate, (b) 
form, (c) size, (d) number, and (e) function. 

(a) The red blood-cells are derived from erytJiroblasts which are 
formed in the bone-marrow; they are destroyed in the liver and, to some 
extent, in the spleen and bone-marrow, (b) The red blood-cell is coin- or 
biscuit-shaped; (c) from 6 to 7.5 microns in diameter; (d) the number in 
adult males is over five millions; in females about four millions in a cubic 
millimeter of blood (Landois). (e) The function of the red blood-cells 
is to convey oxygen to the tissues. 

Describe the red blood=corpusc!es. Give the best known and 
most important function of the red blood-corpuscles. 

Red corpuscles are non-nucleated, biconcave disks 7.5 microns (1/3200 
in.) in diameter; singly, as seen under the microscope, they are green; in 
large masses they appear red. The chief function of red blood-cells is to 
carry oxygen to the tissues. In the capillaries of the lungs the hemoglobin 
contained in the red blood-corpuscles combines with the absorbed oxygen 



I46 PHYSIOLOGY 

to form oxyhemoglobin. The latter is carried to the heart by the pulmo- 
nary veins and propelled by the heart into the general circulation until it 
finally reaches the capillaries, where the oxygen is readily taken up by the 
tissues from the oxyhemoglobin, the oxygen being very loosely combined. 
The blood is then collected from the tissues by the veins and carried back 
to the lungs, where the hemoglobin of the red blood-cells again becomes 
oxygenated. The red cells also carry small amounts of carbon dioxid 
from the tissues to the lungs. 

What is the usual difference in shape between the red blood- 
corpuscles of the mammalia and those of the ovipara? 

Mammals, with the exception of the camel, llama, alpaca, and similar 
animals, all have circular, coin-shaped, biconcave, nonnucleated red 
blood-cells; in the ovipara the cells are oval, biconvex, and nucleated. 

Describe hemoglobin and mention its derivatives. 

Hemoglobin, the coloring matter of the blood, is a colloidal, proteid- 
like substance which, however, is readily crystallizable and contains iron 
and sulphur. It has a strong affinity for oxygen and other gases and gives 
a peculiar spectrum. The derivatives are: hematin, hematoidin, hemin, 
hetnatoporphyrin, and methemoglobin. 

Describe the white blood=corpuscles, giving source, com= 
position, and properties. 

The leukocytes are larger than the red cells, being 1/2500 in. in diam- 
eter, nucleated, and capable of ameboid movement and phagocytic 
action. They contain nuclein, globulin, fat, glycogen, and a nucleopro- 
teid. There are several varieties: small and large lymphocytes; poly- 
morphonuclear, transitional, and eosinophile leukocytes, the last con- 
taining large granules that stain readily with eosin. The leukocytes are 
derived from the lymphatic tissues, the spleen, and the bone-marrow. 

Give the number of leukocytes in shed blood under normal 
conditions. 

5000 to 10,000 in a cubic millimeter of blood. 

What is the ratio of leukocytes to red blood=cells in shed blood 
under normal conditions? 

About 1:500 to 800 (Jaksch). 

Define leukocytosis. 

An increase of the number of leukocytes above 10,000 in a cubic milli- 
meter of blood. 

What explanation may be given for enlargement of the spleen 
in leukocythemia? 

The spleen is one of the organs in which white corpuscles are formed. 

What is the chemical reaction of (a) blood, (b) urine, (c) 
sweat? 

(a) Alkaline; (b) acid; (c) acid during rest, neutral or alkaline after 
exercise. 



mi I ik. u\; i. j 7 

What is the function Of the suprarenal glands? \\ hat is I he 

effa t of their removal? 

The function i^ pnu li* ally unknown; they -ire believed to inhibit exces- 

si\r pigment formation and to destroy certain p 

the body. In Addison's disease, tuberi ulou ation of the SUDfl 

renal glands, the skin is bronxed 

The Injection of suprarenal extra* t causes contraction of the art. 
and an Increase In the blood pressure, frith Blowing of tin- pulse bj central 
stimulation of tin- vagus. Xne heart muscle is also stimulated. 

Extirpation of both glands la followed !>y dead with symptoms of 

planning and paralysis. 

(a) Give function of thyroid gland, (b) What effect does its 
removal have? 

(a) Function unknown. Theories: (i) The thyroid produces an 
internal secretion rich in iodin. This reaches the circulation and con- 
stitutes an important regulatory mechanism. (2) According to another 
theory the thyroids neutralize or destroy toxic substances. 

(I)) Removal of the thyroids and parathyroids in dogs leads to muscu- 
lar tremors, convulsions, emaciation, apathy, and death. It is now gen- 
erally believed that the acute symptoms arise from the ablation of the 
parathyroids. Removal of the thyroids proper leads usually to mal- 
nutrition and a condition resembling myxedema in man. 

THE CIRCULATORY SYSTEM 

State what are, under normal conditions, (a) the adult pulse- 
rate; (b) adult number of respirations per minute; (c) body 
temperature; and (d) average respiratory capacity. 

(a) Seventy-two per minute; (b) 18 per minute; (c) 98. 4 F.; and (d) 
230 cu. in. 

Give the extremes of slowness and rapidity of the heart's 
action consistent with physical vigor and with ability to per- 
form manual labor. 

It is not possible to define the extreme limits, say from 50 to 100 beats 
per minute. 

What causes (a) circulation of the blood, and (b) the beating 
of the pulse? 

(a) The circulation of the blood is caused by the contraction of the 
cardiac muscle, reinforced by the tonicity of the arteries and vasomotor 
system (vis a tergo) and the negative pressure in the venous system. 

(b) The pulse-beat represents the cardiac contractions transmitted to 
one of the peripheral arteries, usually the radial. 

State the manner in which the blood circulates through the 
heart and lungs, beginning at the right auricle. 

From the right auricle through the tricuspid valve to the right ventricle; 
from the right ventricle through the pulmonary valve into the pulmonary 
artery, which carries the blood to the air-cells in the lungs. From the 



148 PHYSIOLOGY 

capillaries surrounding the pulmonary vesicles the blood is collected by 
the pulmonary veins and emptied into the left auricle; thence it pasess 
through the mitral valve into the left ventricle and from there is propelled 
through the aortic valve into the aorta and general arterial system. 

Give the physiology of (a) blushing, (b) pallor, and (c) tear= 
shedding. 

(a) Blushing is due to reflex dilatation of the blood-vessels in the skin 
brought on by stimulation of the vasodilator center in the medulla. This 
stimulation may be brought about by any emotional disturbance. 

(b) Pallor is a reflex constriction of the blood-vessels of the skin and 
is due to reflex excitation of the vasoconstrictor center in the medulla. 

(c) Under the influence of certain emotions, particularly grief and 
vexation, the lacrimal glands are reflexly stimulated through the central 
nervous system to secrete more fluid than can be carried off through the 
nasal duct, and this excess runs over the cheeks in the form of tears. 

Describe a complete physiologic revolution of the heart. 

During diastole the ventricular muscles relax and the blood passes 
from the auricles into the ventricles; the auricles contract as diastole comes 
to an end and force the remaining blood into the respective ventricles. 
With the beginning of systole the ventricles contract, the auriculoventricu- 
lar valves are closed, and the blood is forced into the pulmonary artery and 
aorta, respectively, through the open semilunar valves. As diastole 
begins and the ventricles relax, the semilunar valves close with a snap, 
the auriculoventricular valves being opened by the pressure within the 
auricles and the negative pressure in the ventricles. 

What are the causes of the apex=beat of the heart? 

(a) Impact of the apex against the chest wall ; (b) change in the shape 
of the cardiac cone; and (c) change of position: the ventricles rotate slightly 
around their long axis. 

Do variations in the rate and force of respiration affect the 
heart, and if so, in what manner? 

There is a direct proportion between the rate and force of respiration 
and the rate and force of the heart-beats. A deep inspiration held for 
some time will reduce the frequency of the heart. 

What nerves control the action of the heart? 

(a) Intrinsic mechanism, consisting of ganglia in the heart wall; (b) 
extrinsic mechanism, consisting of cardio-inhibitory and cardio-accelera- 
tor fibers. 

The cardio-inhibitory center is situated in the nucleus of the spinal 
accessory nerve and the impulses are conveyed through fibers of that 
nerve to the pneumo gastric, which is the great cardio-inhibitory nerve. 
The cardio-accelerator center is hypothetic and is probably situated in 
the medulla. The fibers pass out through the first five dorsal nerves 
(particularly the second and third) to the sympathetic ganglia, from which 
fibers pass to the heart as the cardiac sympathetic nerves. The pneumo- 
gastric nerve also contains some accelerator fibers. 



In \\li;il manner is the luart-hc.it intliicru cd In the piuimm- 

gaatrlc nerve? 

Mimulalion o| the pncui: ol tin- }■ 

It tlu- stimulation i^ continued, the heart ix-.it i^ accelerated, because the 
accelerator fibers in the pneumogastrii arc itimulated after the Inhibitory 
fibers have corned to react 

State the causes of the pressure in the a arteries, h capil- 
laries, ami c veins. 

rhc propelling force of tin* left ventricle and the resistant e <»f the 

elastic arterial wall under the intluence of the VaSOCOnstlictOI (enter. 

(hi The vis <j Urgo % derived from the arteries, 

(c) In the lippei veins near the heart the negative pitSSUre of the heart 

during diastole, vrhicfa diminishes in proportion to the distance from the 

heart. The contraction of the muscles surrounding the veins and the 
valves iound in some portions of the hody also assist in keeping up the 
venous pressure. 

What do you understand by blood-pressure? 

The tension or pressure of the blood in the circulatory system. In 
the larger arteries (radial) it is equal in the adult to from 120 to 150 mm. 
of mercury. 

Describe the conditions within normal physiologic limits 
which increase arterial blood=pressure. 

Whatever directly or indirectly increases the force of the heart-heat or 
stimulates the vasomotor center, as digestion, and especially exercise and 
emotion. 

Describe the pulse mechanism, state the factors active in its 
maintenance, and give the average rate during infancy, youth, 
and adult age. 

The pulse-wave is due to the projection of a certain quantity of blood 
into the arterial system, causing an additional distention of the already 
tilled vessels. The factors active in its maintenance are the force of the 
heart, the controlling intluence of the cardiac mechanism, and the elasticity 
of the arteries. The normal pulse should be full, of moderate tension, 
regular, and of the normal frequency, which is 130 to 140 during infancy, 
80 to 90 during youth, and 70 to 80 during adult life; normal, 72. 

What effect has bodily exercise on the rate of the heart's 
action, and why? 

It increases the rate and force of the cardiac contractions in order to 
supply the increased demand for oxygen on the part of the tissues (con- 
tracting muscles, etc.), and provide for the increased elimination of waste 
material through the blood stream. 

Mention some of the exercises that injuriously affect the 
heart. State the reasons for your conclusions. 

Any exercise which throws a sudden strain on the heart has a tendency 



150 PHYSIOLOGY 

to cause dilatation and eventually hypertrophy. Among these may be 
mentioned wrestling, bicycle riding, long distance running, and rowing, 
especially in a race. 

What are the functions of the blood=vessels? 

They convey the blood to and from the various parts of the body, dis- 
tributing the nutritive substances to the tissues and removing the waste 
materials, which they carry to the organs through which they are excreted. 
They also regulate the amount of blood going to various portions of the 
body, control the amount of work that is thrown on the heart, and assist 
in maintaining the normal body heat. 

Describe the structure of the arteries. How do arteries 
exercise their function? 

Arteries are provided with three coats, the tunica intima, media, and 
adventitia. The intima consists of an inner layer of endothelial cells 
and a layer of yellow elastic tissue. The media is principally made up 
of circular fibers of involuntary muscle containing a number of elastic 
fibers. The media contains ganglionic masses which represent the end- 
ings of the vasomotor nerves. The adventitia, or outer coat, contains 
yellow elastic fibers and strands of fibrillated connective tissue. 

The arteries exercise their function of conveying the blood to the tissues 
by virtue of their inherent elasticity, due to the elastic tissue contained 
in their coats and the influence of the vasomotor center on the muscular 
fibers. 

How do veins, arteries, and capillaries differ as to (a) struc= 
ture and (b) function? 

The arterial walls contain more muscular and elastic tissue than that 
of the veins. Veins are larger in caliber than their corresponding arteries; 
their walls are thicker and many of them are provided with valves, which 
are not found in arteries. The walls of the capillaries consist of a single 
layer of nucleated, spindle-shaped, and polygonal endothelial cells. 

The arteries convey the blood from the heart to the capillaries, and 
the veins carry it back to the heart. The capillaries effect the interchange 
of nutritive substances from the blood to the tissues by means of osmosis 
and diapedesis, and carry away waste material in the opposite direction. 

How is the venous blood=current maintained? What arteries 
carry venous blood? 

By the vis a tergo, or force of the heart, transmitted through the arteries 
and capillaries; the contraction of the surrounding muscles; the action 
of the valves in some of the veins; and (in the large veins near the heart) 
the negative pressure in the right side of the heart during diastole. 

What is the relation of the capillaries to the circulation? 

They form the intermediate link between the small arterioles and the 
smallest veins. 

Describe the process of osmosis, and give examples in the 
human economy. 

Osmosis is the diffusion of liquids through a porous membrane. The 



, 5 I 

correal b in the dire* don from the liquid of 1 ty to the 

liquid of lower ipedn< gravity «»i concentration. The liquidi mu 
hum ible, of different ipe* Ific gnu Ity, rod i tpable of wetting the membrane 
wit in mt acting on it mechanicall} . rhe olid con tdtuenti mutt I 
loid In order to paai through tin- membrane. 

I Eamplei In the human nniiiiniv an- the j 

the capillary wall Into the tissues in both din ami the p 

glucote bom the Inteatine into the portal circulation* 

Describe the mo\cmcnts of the blood-corptisc les in the 
capillaries, aiul explain the phenomena <>t diapede>is. 
The nd COipuadea OCCUpy the central or axial portion of t! 

and travel more rapidly than the white blood I elK whii h have a ten 

to adhere to the ve»el wall. The capillaries are JUSl large enough to 

allow the red blood-corpuscles to pass through in single file, and at the 

junction of two capillaries they take alternate turns in passing into one 
or the other. 

The white blood-cells, by virtue of their ameboid movement, are able 
to pass through the capillary wall. One of the pseudopods is thru>t 

through the cement substance between the cells of the capillary wall and 
then pulls the rest of the cell body through after it. This process is 

called diapedesis. 



RESPIRATION 

Define the process of respiration? 

External respiration consists in the interchange between gases of the 
outer air and those of the blood contained in the lungs and skin; internal 
or tissue respiration is the exchange of gases between the capillary blood 
and the body tissues. 

What is the purpose of respiration? 

To supply the body with the necessary oxygen for its oxidation pro- 
cesses and to remove the carbon dioxid resulting from combustion. 

Give the mechanism of respiration. 

This consists in alternating dilatation and contraction of the thoracic 
cage; the dilatation is termed inspiration and the contraction, expiration. 
The lungs lie wholly passive within the thoracic cavity, and by virtue of 
their complete elasticity follow every change in the capacity and shape 
of the thorax. Enlargement of the thorax is effected by certain muscles 
known as the muscles of inspiration; the diaphragm descends and at the 
same time is withdrawn from the chest walls: the ribs are elevated and 
rotated outward. At the end of inspiration the muscles relax and the 
thorax collapses, expiration being usually a passive process due to the 
elasticity of the lungs, the weight of the chest, the tension of the abdominal 
muscles, and the torsion of the costal cartilages. It is also assisted to 
some extent by the action of the muscles of expiration. The respiratory 
movements are controlled by a center in the medulla. 



152 PHYSIOLOGY 

State the changes in the diameter of the chest in inspiration 
and expiration. 

During inspiration the vertical diameter is increased by the descent of 
the diaphragm ; the posterior and transverse diameters by elevation, ever- 
sion, and anterior and lateral rotation of the ribs. During expiration the 
original conditions are restored. The circumference of the chest, measured 
at the level of the nipples, is increased by from one-twelfth to one- 
seventh of the circumference in the expiratory position. 

How is the diaphragm affected in expiration? 

The central tendon of the diaphragm is drawn up into the thorax dur- 
ing expiration by the negative intrathoracic pressure, which results from 
the collapse of the lungs and in part from the contraction of the abdominal 
muscles. 

Give the mechanism of the diaphragm in hiccough. 

The muscle is thrown into sudden spasmodic contraction, causing a 
jerky inspiration, which is arrested by sudden closure of the glottis. 

What is the normal ratio of respirations to heart pulsation? 

In adults one to four; in infants one to two. 

Define and describe (a) respiratory rhythm, and (b) respira- 
tory sounds. 

(a) The time relation between the two respiratory phases; inspiration 
is to expiration as five to six, expiration being followed by a short pause. 

(b) There are two varieties of respiratory sounds: Vesicular breathing 
and bronchial breathing. Vesicular breathing is low-pitched and soft, 
and is described as breezy, sipping, rustling, or hissing; expiration is some- 
what lower in pitch, less loud, and shorter than inspiration, the relation 
being as one to three or four. It is heard over pulmonary tissue. Bron- 
chial breathing, heard over the trachea and large bronchi, is blowing or 
tubular in quality, and expiration is louder, longer, and higher pitched 
than inspiration. 

Describe the function of the mucous membrane of the res= 
piratory tract. 

1. The mucus secreted by the glands arrests dust particles and other 
foreign bodies in the inspired air, and the ciliated epithelial cells keep 
the lungs clear of accumulations of mucus and the suspended dirt particles. 

2. The squamous cells lining the air vesicles, by virtue of their vital 
activity, play a part in the exchange of respiratory gases. 

What changes are produced in the air and in the blood by 
respiration? 

Expired air is warmer, contains less oxygen, and more carbon dioxid, 
nitrogen, and water than inspired air. It also contains volatile organic 
substances. The blood coming from the lungs contains more oxygen, 
and less carbon dioxid and nitrogen, than that entering the lungs. 



PIS \ll<>\ 
I How is asphyxia produced? 2 What arc the rilHHi Ofl 

death from ttphj ua? 

By the failure <•! air to enter the lungs, as in obstrw ti<m of the air- 
passage by false membram pi body, or by external i on tri 

as ia strangulation. The absence ol oxygen in tin- inspired air. \ 
thing that interferes with the suppi\ -m t«» th« as edema 

ol tin- lungs, or other diminution of the respiratory surface, 01 cardiac 
insufficiency. 

Death from asphyxia ia caused by deficiei and th«- 

accumulation ^i carbon dioxid in the blood. 

Define and give the physiologic significance of (a) dyspnea, 
(b) dysphagia, and (c) apnea. 

Difficult and rapid breathing due either to a lark of oxygen or to 

an excess oi carbon dioxid in the Mood. In oxygen dyspnea the inspira- 
tions arc frequent and vigorous; carbon dioxid dyspnea ia i haracterized by 

slow, deep, and vigorous expirations. Dyspnea in di-ease of the heart 
and lungs is chiefly due to a lack of oxygen; dyspnea following exertion 
is due to the action on the respiratory center of accumulated carbon dioxid. 

(I)) Difficult or painful deglutition from obstruction or spasm of the 
esophagus, or painful affections of the thorax. 

(c) Cessation of breathing due to mechanical excitation of the pul- 
monary plexus of the pneumogastric nerve, which inhibits the respiratory 
center, and the storage of sufficient oxygen in the lungs to last through 
one circuit of the blood through the body. 

What is the composition of atmospheric air? State the per- 
missible limit of C0 2 in air. 

Air is a mechanical mixture containing oxygen, 20.92 per cent, (by 
volume); nitrogen, 79.02 per cent.; C0 2 0.029 to 0.034. It also contains 
1 per cent, of argon; helion, crypton, and certain other gases. Air con- 
tains a variable quantity of aqueous vapor. 

The permissible limit of CO, in air is 0.07 per cent. 

Define (a) tidal air, (b) complemental air, (c) reserve air, 
(d) residual air, and (e) respiratory capacity. 

(a) The normal flow of air in the lungs, amounting to 30 cu. in. or 500 
cc. ; (b) the amount of air which may be inspired after an ordinary inspi- 
ration; it is equal to 100 cu. in. or 1500 cc; (c) the amount of air which 
may be expired after an ordinary expiration; it is equal to 90 to 120 cu. in. 
or 1250 to 1800 cc; (d) the air which remains in the lungs after a forced 
expiration and which cannot be forced out; it amounts to 90 to 100 cu. in., 
or 1200 to 1500 cc. (e) By respiratory or vital capacity is meant the vol- 
ume of air which can be expired after forced inspiration; it therefore in- 
cludes the reserve, tidal, and complemental air. In man it amounts to 
about 3400 cc; in woman, 2500 cc 

What is the volume of air taken into the body during an 
ordinary inspiration? How much of this is oxygen and how 
much of the oxygen is absorbed? 

This is equal to the tidal air and amounts to 30 cu. in. or 500 cc ; of this 



154 PHYSIOLOGY 

20.92 per cent., or 6.27 cu. in. or 104 cc, is oxygen. About 5 per cent., or 
5.2 cc. of oxygen, is absorbed. 

Locate the respiratory center. 

The respiratory center is situated in the medulla oblongata behind the 
point of exit of the vagi, at the posterior extremity of the floor of the fourth 
ventricle. It is bilateral, each half governing its own side of the body 
particularly, but not exclusively. 

State the effect on respiration of dividing (a) one phrenic 
nerve, and (b) both phrenic nerves. 

(a) Unilateral paralysis of the diaphragm and cessation of diaphrag- 
matic breathing on the side of the lesion; and (b) complete cessation of 
diaphragmatic breathing and death. 

DIGESTION 

What is meant by digestion? 

The process by which the food ingested is prepared for absorption 
within the body. 

Name the secretions of the alimentary canal, their reactions, 
and functions. 

Saliva: Alkaline; assists in forming the bolus and lubricating it for 
deglutition, and converts starch into maltose. 

Gastric Juice: Acid; inhibits fermentation, converts proteids into 
peptones, and coagulates the casein of milk. 

Pancreatic Juice: Alkaline; continues the process of changing pro- 
teids into peptones and starch into maltose; converts caseinogen into 
casein, and splits up, saponifies, and emulsifies fats. 

Bile: Alkaline; contains no ferments, assists in neutralizing the acid 
chyme, aids in the emulsification and in the absorption of fats, stimulates 
peristalsis, counteracts putrefaction, and acts as a lubricant to the intesti- 
nal wall. 

Succus Entericus: Alkaline; is secreted by the crypts of Lieberkuhn; 
changes maltose into glucose and saccharose into sugar. Its digestive ac- 
tion is very feeble. 

Name the active principles of the digestive secretions and 
state how each affects the food. 

Saliva: Ptyalin in saliva changes starch into maltose. 

Gastric Juice: Pepsin in the presence of hydrochloric acid converts 
proteids into albuminoses and peptones. Rennin, the milk-curdling 
ferment, converts caseinogen into casein. Lactic-acid ferment converts 
sugar of milk into lactic acid. 

Pancreatic Juice: Trypsin changes proteids into peptones; amylopsin 
changes starch into maltose; steapsin splits up fat into fatty acids and 
glycerin; rennin coagulates milk; invertin changes maltose into dextrose; 
and saccharose into equal parts of dextrose and levulose. 

Succus Entericus contains an amylolytic ferment of feeble activity, 
and invertin. 



DIC1 i 155 

lin 1 contains n>> ferment, hut 

(iive the sources and physical properties of MllVA« 
Saliva i^ se< reted bv the parotid, lubnuudllaiy, And subli 
It ifl an opalescent, laMeless, and odorless, oincuh.it ropy lluid, with a 
medfic p»vitj Of tOOa U) ioo(>, and U alkaline reaction due to alkaline 

phosphati 

State the composition and mechanical functions of the sali\a. 
\\ hat relation does the salisa hear to the sense o! t.tMc? 

;<mi<- constituents: an albuminous substance, mm in, and ptyalin. 
Inorganic constituents: sodium chlorid, potassium chlorid, potassiuni 
fate, and alkaline and earthy phosphates. (See also p. 83.) 

The saliva dissolves arti< lea of food soluble in water; "HAifftww ra< fa 11 
are ingested in the dry state, assists in the formation of the bolus, and 
facilitates deglutition by lubricating it with mucus. 

In order that a substance may make a gustatory impression, it must 
he soluble in the saliva; insoluble substances have no taste. 

What influences has the saliva on digestion? 
The secretion is amylolytic or diastatic, that is, it converts starch into 
maltose and dextrose. The action is due to ptyalin. 

What are the uses of (a) saliva, (b) trypsin, and (c) amylopsin? 

(a) The uses of saliva have been described. 

(b) A proteolytic ferment; continues the digestion of proteids in the 
intestines, being active in an alkaline medium only. 

(c) Amylopsin is a constituent of the pancreatic juice and digests 
starch in the intestines. It is twenty times more powerful than ptyalin 
and digests raw, as well as boiled starch. 

What special senses influence the flow of saliva? 

Taste, smell and hearing. 

What would be the effect on the saliva and digestion if Sten- 
son's duct should be divided? 

If one of the ducts only were divided, the parotid gland of the other 
side would undergo compensatory hypertrophy and digestion would be 
but little interfered with. At first the saliva would probably be more 
viscid and the digestion of starches somewhat retarded. Division of 
both ducts would practically abolish the digestion of starch in the mouth, 
as only a small quantity of ptyalin furnished by the submaxillary glands 
would be available. 

Mention the difference between parotid and sublingual saliva. 

The parotid saliva contains more ptyalin, the sublingual more mucin. 

What action have atropin, pilocarpin, and nicotin upon the 
salivary glands and their secretion? 

Atropin inhibits, and pilocarpin and nicotin stimulate the secretion of 
the salivary glands. 



156 PHYSIOLOGY 

Describe the stages of deglutition. 

Buccal Stage: The mouth is closed and the jaws are pressed together 
by the muscles of mastication. Successive parts of the tongue, from 
the tip to the back, are pressed against the hard palate, forcing the bolus 
of food into the pharynx. 

Pharyngeal Stage: Return of the bolus to the mouth is prevented by 
the contraction of the palatoglossus, which brings the anterior palatine 
arches in contact with each other, and of the styloglossus, which raises the 
back (base) of the tongue. The larynx is pulled upward and forward 
and the glottis closed by approximation of the vocal cords (assisted possi- 
bly by the epiglottis) . The soft palate is raised by the levator palati, the 
nasopharyngeal cavity is closed, and the bolus forced into the esophagus 
by the successive contraction of the three constrictor muscles of the 
pharynx. 

Esophageal Stage: The food is forced downward into the stomach 
by the peristaltic contraction of the esophageal muscles. Liquids are 
forced through the pharynx and esophagus by the vigorous contraction of 
the mylohyoid muscles. The first stage is voluntary, the second and 
third are reflex in character. 

Mention the muscles brought into action during the act of 
deglutition. 

Orbicularis oris, muscles of mastication, mylohyoid, levator veli 
palati, constrictors of the pharynx, and the involuntary muscle fibers of 
the esophagus. 

Describe the act of mastication. 

By the act of mastication the food is ground and, after thorough mix- 
ture with the saliva, formed into an oblong mass, the bolus, when it is 
ready for deglutition. Separation and grinding is effected by the teeth, 
under the action of the muscles of mastication, and the tongue assists in 
mixing the food with saliva and forming the bolus. 

Name the muscles of mastication. 

Buccinators, temporals, masseters, and internal and external ptery- 
goids. Accessory: digastric, mylohyoid and geniohyoid, and platysma 
myoides. 

Describe the physiology of vomiting. 

The vomiting center is situated in the medulla oblongata. The act 
may be excited by irritation of the centripetal nerves of the palate, tongue, 
pharynx, or stomach (glossopharyngeal and pneumogastric nerves); 
reflexly by irritation of the uterus in pregnancy, the intestines (peritonitis), 
or genito-urinary tract; by the sight, smell, or taste of repulsive objects or 
by repulsive conceptions; and, finally, by direct stimulation of the vomit- 
ing center (apomorphin). 

During the act of vomiting the walls of the stomach contract, while 
the cardia is held open by the contraction of the longitudinal fibers. Ejec- 
tion of the contents is assisted by forcible contraction of the abdominal 
muscles (except in children). 



DIG 

Describe the vermicular movement <>i the- stomach and 

Intestines. What purpose does this movement lOTVe? 

The vermicular movement 01 perisUUsi «»i the itomachand i 
is a period ir; ill \ recurring, p ntra< tion <•! tin- v. all •, beginning 

(in the stomach) .it the fundus ind ending at tin- pylorus, attended b) 
the rhythmicsi opening snd closing ol the pylorui I sen perl 
u aw lasts t\\ 1'iity Beconafl snd b separated from th by an 

Interval ol fifteen to twenty seconds. In objei I i- t<> fori e the 
Intestinal contents onward and toward the anus. Pendulum like more 
meats also tike pls< e, moving die contents first In one direi don and then 
m the other. Peristalsis la most marked In the small intestine; in tin 
bowd the movements are less active and less extensive. 

Name the centers and the nerves which regulate intestinal 
peristalsis and describe their action. 

The automatic center re-ides in the myenteric plexus (Meissner'fl 
plexus), which lies embedded in the muscular coat Spei ial nerve plei 
Bses, containing ganglia, are found upon the blood-vessels and lymph- 
vessels oi the intestinal walls. The nerves are the pneumOgOStric and the 

greater and lesser splanchnic nerves. The pneumogastric increases per- 
istalsis and also contains some inhibitomotor fibers. The splanchnic in 
the inhibitory nerve of the intestinal movements; it also contains the nerves 
of sensation. 

Describe the muscular and nervous mechanism of defecation. 

Defecation is a combined volitional and retlex act which begins with 
active peristalsis in the large intestine. The external sphincter, having 
been relaxed voluntarily, and the internal sphincter as explained in next 
question, a deep inspiration is taken, followed by an expiratory effort with 
the diaphragm fixed. The abdominal muscles are forcibly contracted, 
the rectum straightens out, and the soft parts of the pelvic tloor are forced 
downward conically, while the levator ani muscle elevates the anus, and 
the column of feces is expelled. 

The nervous mechanism consists of the reflex anospinal center in the 
cord, the inhibitory center in the brain (see next question), and the 
sensory nerves of the rectal mucous membrane and sympathetic fibers 
going to and from the plexuses of Meissner and Auerbach. 

Explain the action of the anospinal center in defecation. 

Budge's anospinal center is the reflex center for defecation. Irritation 
of the sensory r nerves of the rectum by the descending fecal mass causes 
reflex stimulation of the internal sphincter. The center for this reflex is 
Budge's anospinal center, situated in the lumbar cord. During defecation 
this reflex is temporarily abolished by the activity of an inhibitory center 
which is capable of voluntary stimulation; the latter is situated in the 
brain, probably in the optic thalamus, and connected with the anospinal 
center. During the stimulation of this inhibitory center the column of 
feces passes through the rectum without causing its reflex closure. 

Describe gastric digestion with special references to the 
changes effected upon the types of food. 



158 PHYSIOLOGY 

The mixture of finely divided food and gastric juice is called chyme. 
As soon as the food enters the stomach certain movements are set up in 
the viscus: First, the rubbing movement, by which the walls of the stomach 
lying in immediate contact with the ingesta move to and fro with a slow, 
displacing action. These movements are periodic, each cycle lasting 
several minutes. Second, gastric peristalsis, which also recurs periodically 
in conjunction with the rhythmic opening and closing of trie pylorus. 
As a result of peristalsis the chyme is, little by little, propelled into the 
duodenum, the first portion passing the duodenum about fifteen minutes 
after ingestion, and the process being completed at about the fifth hour. 
The secretion of gastric juice begins with mastication and deglutition, 
and is further stimulated reflexly when the endings of the sensory fibers of 
the pneumogastric are irritated in the stomach by the food. The conver- 
sion of starches into maltose under the influence of the ptyalin of the saliva 
continues in the stomach until the process is arrested by the increasing 
acidity of the gastric juice. There is no action on fats, but the connective 
tissue is digested by the pepsin, liberating the fat-cells and preparing them 
for emulsification in the small intestine. The chief digestive action of 
the stomach is on the proteids. Pepsin in the presence of hydrochloric 
acid converts the proteids into albumoses, and finally into peptones. Ren- 
nin coagulates milk and changes caseinogen into casein. 

Describe the different glands of the stomach. 

The gastric glands are of two kinds: the peptic glands, situated at or 
near the fundus, and the pyloric glands. The peptic glands contain the 
chief or central peptic, and parietal or acid cells and secrete hydro- 
chloric acid. The pyloric glands are not supplied with parietal or acid 
cells and secrete only ferments. 

Describe by drawing or otherwise a peptic gland. 

A simple tubular gland presenting a duct, a neck, and a tortuous or 
spiral fundus, which is sometimes divided. It has two kinds of cells, 
chief or central cells which bound the lumen and secrete pepsin and remain, 
and parietal or acid cells, situated at the periphery of the gland, which 
secrete hydrochloric acid. 

Give the principal characteristics of gastric juice in man. 

A clear, colorless, levorotatory fluid, strongly acid in reaction, with an 
acid taste and characteristic odor. The specific gravity is about 1005. 
The daily amount is said to be about one-tenth to one-fifth of the body- 
weight. The normal juice contains water, mucin, hydrochloric acid, 
pepsin, rennin, and, possibly, some lactic acid and inorganic salts. 

What effect have strong alcoholic stimulants on the gastric 
juice? 

They abolish the secretion. 

What prevents digestion of the stomach by its own juices? 

Two factors are mentioned in explanation: (1) The alkalinity of the 
blood, protecting the tissues against the action of the gastric juice, which 
requires an acid medium, and (2) the thick, firmly adherent layer of 



DK 

mint: ; thr walls of tlu* viscui With regard to the forma 

c\fi . it must be remembered thai the stomach has been ihown to be capable 

of ilii'i-Mii i»I a living l-.xlv (the !<•:- ul .1 frog, I rab All 

that ran Ik* said in explanation is that full) living DrOtOpU m, !m-ih e 

als*> that of the epithelial cells of the itomach, is capable ol / the 

action oi peptonizing enzymes, Amelia-, bacteria, pfoi ma, and embr 
sole cells are not anected bj artificial digestive ju 

w hat circumstances favor gastric digestion? 
Among the many circumstances favoring gastric digestion are thor- 
ough mastication, do* eating, pleasant taste of the food, swallowing in 

small mOUtfafuls, normal amount of condiments, mU&CUlai and mental 

quietude, ^\\A a general healthy condition of the various parts of the body. 

Give the reactions of the following fluids and state the cailSC 
oi the reaction in such a case: (a) urine, (b) blood, (c) gastric 
juice, and (d) pancreatic juice. 

Acid from the presence of arid salts, especially add sodium phos- 
phate. 

(h) Alkaline from the presence of sodium salts, especially sodium 
carbonate. 

(c) Acid, due to hydrochloric acid. 

(d) Alkaline, due to the presence of 0.4 per cent, sodium carbonate. 

Discuss the action of the gastric juice on carbohydrates and 
fats. 

The ptyalin of the saliva is active in the stomach until it reaches about 
0.5 per cent, (about a half-hour after the individual has begun to eat). 
The small amount of mucin may ferment some of the sugars. 

The gastric juice has practically no effect on fats, beyond digesting the 
connective tissue and setting free the fat globules. 

What are the functions of the pancreas? 

Besides secreting the pancreatic juice and taking a prominent part 
in digestion, it is probable that the gland yields a glycolytic ferment to the 
blood, which in some as yet unknown manner decomposes the sugar in the 
blood. This ferment is absent in diabetes (occurrence of diabetes after 
extirpation of pancreas). 

Describe the pancreatic juice, mentioning its ferments and 
stating their specific actions. 

An alkaline, clear, viscid, odorless, and colorless fluid containing the 
following ferments: 

1. Amylopsin: converts starch into maltose and dextrin, like the ptyalin 
of saliva. 

2. Trypsin: converts the albuminates into albumoses or propeptones 
and then into true peptones. 

3. Steapsin: breaks up fat into fatty acids and glycerin, from which 
soaps and emulsions are formed. (The only fat-splitting ferment in the 
digestive tract.) 

4. Rennin: like the rennin of gastric juice, except that it requires an 
alkaline medium. 



l6o PHYSIOLOGY 

5. Invertin: converts maltose into dextrose. 
Define emulsification and saponification. Illustrate. 

Emulsification is the breaking up of fat into very small particles and 
holding them in suspension in a liquid in which they will not dissolve, 
as mixing together oil and water. 

Saponification is the replacing of the glycerin of a fat by an alkali, as 
the mixing of olein and sodium hydrate to form sodium oleate and glycerin. 

What would be the effect on digestion if the pancreatic duct 
were obstructed? 

As the pancreatic secretion acts on all kinds of food, this action would 
greatly interfere with digestion in general, especially that of the fats and 
carbohydrates. 

Describe the portal circulation. 

The blood collected from the capillaries of the spleen, stomach, and 
intestines by the splenic, gastric, and mesenteric veins is carried by the 
portal vein to the liver. Here this vein breaks up into smaller vessels 
running between the lobules, called the interlobular veins. From these 
veins capillary vessels pass from the periphery of the acinus toward its 
center, running along the edges of the rows of liver cells. At the center 
these capillaries unite to form the central or intralobular vein which, after 
piercing the lobule, becomes the sublobular vein and unites with similar 
vessels from adjoining acini to form large trunks, the roots of the hepatic 
vein, by which the blood is returned to the inferior vena cava. 

The branches of the hepatic artery accompany the larger branches of 
the portal vein and supply nutrient capillaries to the capsule, the ducts, 
and the branches of the portal vein. 

What changes occur in the blood in its passage through the 
liver? 

Blood going to the liver contains more proteids, fats, and organic sub- 
stances; it is more coagulable; contains less sugar, extractives, and urea; 
and is lower in temperature than that coming from the liver. 

What is accomplished physiologically by the portal circu- 
lation? 

The great bulk of the products of digestion (proteids, carbohydrates, 
alcohol, water, and salts) are carried to the liver by the portal vein. 

Name the varieties of blood that circulate in the liver. State 
their sources and give the destinations and functions of each. 

Arterial Blood: The hepatic artery, a branch of the celiac axis, supplies 
numerous capillaries to the larger branches of the portal vein and to the 
bile-ducts. Some small capillaries pass from the periphery of the acinus 
into the capillaries of the portal system ; others pass over into two venous 
trunks which empty into the portal vein. 

Portal Blood: The portal blood passes from the stomach to the pancreas 
and spleen and brings material for the manufacture of bile and glycogen. 



LI.. I ! . I'M 

The portal vein ultimately formi the Lnterlobul I 

veins capilhirii- rom tin- periphery toward the cent they 

unite to form the central or Intralobular win, which In turn p 

lobule vertically and at the 'in- lublobular vein 

sublobular veins unite t«> form larger trunks thai repre enl the 

the hepatic veins. 

i m i bleed Is collected by tin* hepatic veins and emptied Into the 
inferior vena cava at the surface o! the liver. 

Describe bile and its uses. 

\ Quid varying from yellowish brown to dari 
sweetish bitter taste, musk like odor, and feebly add or neutral re- 
action. Specific gravity, toa6 to 103a, 

Where is the bile first formed? Trace its course. 
The first biliary passages, the bile capillaries, originate In t] 

of the acinus, lying midway between two surfaces of adjacent liver cells. 
Leaving the acini, they unite to form larger bile-ducts, which finally en 
at the transverse fissure as the hepatic duct. The latter unites with the 

Cystic duct to form the common bile-duct, which enter- the second segment 
oi the duodenum and is joined by the pancreatic duct ju>t before its termina- 
tion. The opening in the duodenum is marked by a papilla. The dilata- 
tion of the duct below the juncture with the pancreatic duct is known as 
the ampulla of Voter. 

Name the bile salts. 

The bile salts are sodium glycocholate and sodium taurocholate. 

State (a) the origin, (b) nature, and (c) destination of the 
glycogen of the liver. 

(a) The carbohydrates of the food; only sugars fermentable by yeast 
form glycogen. 

(b) Proteids, including gelatin, fats (olive oil), and glycerin. Glyco- 
gen is derived from the carbohydrate food ingested and is temporarily 
stored in the liver cells like starch in plants. It is an animal starch, there- 
fore a carbohydrate soluble in water. 

(c) It is subsequently transformed into grape-sugar, which is later 
destroyed in part in the blood on its way through the tissues, and in part 
by a special ferment derived from the pancreas. A portion of the sugar 
in the blood is converted into glycogen in the muscles. 

What other substances than bile are found in the liver? 

Glycogen, fats, sarcolactic acid, cholesterin, urea, uric acid, leucin and 
tyrosin, pigments, iron (ferratin), and inorganic salts. 

What are the physiologic functions of the liver? 

1. Formation of bile. 

2. Formation of glycogen and fat. 

3. Formation of urea, uric acid, and attendant by-products. 

4. Decomposition of red blood-cells and hemoglobin. 

5. Destruction of certain poisons. 



l62 PHYSIOLOGY 

Describe the glands and villi of the intestines. 

The glands of Brunner are short, compound, branched, tubular glands 
found dipping down in the mucous membrane of the upper part of the 
duodenum. The crypts ofLieberkiihn are simple tubular depressions in the 
mucous membrane of both the small and large intestines. They consist 
of a basement membrane lined with columnar and goblet-shaped epithelial 
cells. A villus consists of a mass of adenoid tissue covered with a layer of 
columnar epithelium resting on a basement membrane. The center of 
this adenoid tissue contains a small lymphatic vessel called a lacteal. The 
adenoid tissue also accommodates many capillaries which coalesce to form 
venules of the mesenteric veins. The large intestine does not contain 
lacteals. 

Describe (a) chyme and (b) chyle. 

(a) The mixture of finely divided food and gastric juice. A semifluid 
grayish, acid substance, containing but little digested material. 

(b) The fluid lymph contained in the lymphatic vessels {lacteals) of the 
digestive tract. It is alkaline in reaction and contains fats, glycerin, and 
lymph-cells, 14 per cent, of fat, and small quantities of sugar, peptones, and 
salts. 

State the origin and uses of the lymph. 

Lymph originates in the lymph-spaces that surround the blood-vessels 
and unite to form the lymphatic vessels. It is derived from the blood, 
which contributes a modified plasma that has osmosed through the walls of 
the capillaries, and from the lymph-glands, which contribute lymphocytes. 

Uses: 1. It conveys fluid and the products of digestion. 

2. Removes effete matter from the tissues. 

3. Relieves the blood- vascular system of excess of fluid. 

4. Acts as a powerful solvent (hypodermic medication). 

5. It is a reserve for the blood to draw on after hemorrhage or during 
starvation. 

6. A lubricant in synovial and other fluids. 

7. Takes part in the healing of wounds (glazing of the wound surface). 

8. Special functions connected with the special senses (cerebrospinal 
fluid, lacrimal secretion, aqueous humor, etc.). 

Discuss bacteria in the intestines. 

Both pathogenic and nonpathogenic bacteria are found in the intesti- 
nal tract. The latter, which play a part in digestion, are schizomycetes, 
and excite fermentation and putrefaction. They are called organized 
ferments in contradistinction to the inorganic ferments of the digestive 
secretions. The intestinal bacteria are divided into: (a) zymogenic — 
exciting fermentation ; (b) chromogenic — producing pigments; (c) bromo- 
genic — generating bad odors; (d) pathogenic — causing disease (Bacillus 
coli communis, Bacillus typhosus, etc.) ; and (e) toxicogenic — elaborating 
poisons. 

Bacillus acidi lactici and Bacillus butyricus are examples of bacteria 
that act on carbohydrates. They convert sugar into lactic acid, and lactic 
into butyric acid, with the production of carbon dioxid and hydrogen. 
Other putrefactive bacteria assist in the conversion of neutral fats into 



fitly ; u ;,i I be u •• ■ i ' digc tion of pi 

practically connned to the large Intestine. Indol (iron i katol 

(from albuminoui robttano ol, valerianic acid, arnmonia, car boo 

dioxid, hydrogen, hydrogen sultid, and m.i ■■;' the 

producti oi proteolytic bacteria. 

What digestive Changes take plate a iii the small intestine, 

and (b) the huge Intestine? 

Protesda that have been acted upon by the gastric juice, and die 
albuminosea are converted into peptones; fata are split up and emu] 
by the anion oi the bile and trypsin in the pancreatic juice. Undta 
starch b changed t»> maltose, which in turn ifl i hanged into dextrose by the 
amylopsin oi the pancreatic juice Hie luccua entericua probabl] 
tains an amvlolvtic inverting ferment which, however, has little digestive 
power, its chief function is to keep the intestinal content- in solution. 
(b) Islcrobic digestion ia carried on in the lower part ol the small, and 
in the large intestine, resulting in the formation of putrefactive products; 
carbon dioxid, methane, hydrogen Bulfid, hydrogen, phenol, indol and 

skatol, valerianic acid, leucin, and tvrosin. There is hut little digestion 
by organized ferments in the large intestine; the intestinal contents move 
slowly, however, and considerable absorption takes place. 

FOODS 

What is food? State why milk is so nearly a perfect food. 

Food is any substance which, taken into the body, builds new tissue or 
supplies heat. 

Milk in the correct proportions contains all the chemical compounds 
necessary to life, that is, proteids, carbohydrates, fats, salts, and water. 

Discuss the effect of the cooking of food as a means of ren- 
dering it more digestible. 

In general, cooking softens the food so that it can be masticated and 
more easily digested; destroys all parasites and disease germs that may 
be present, and develops certain flavors which increase the appetite and 
add to the enjoyment. It destroys the tough fibrous envelopes that sur- 
round many foods. On starchy foods cooking acts by breaking up the 
cellulose covering of the starch granules, so that they can be more readily 
acted upon by the various digestive tluids, and by changing some of the 
starch into dextrin. The effect of cooking on proteids is to cause coagula- 
tion and to develop savory odors and flavors from the various extractives. 
Proteids are not always benefited by cooking, uncooked albumin being 
sometimes more readily digested than coagulated cooked albumin, as, for 
example, in the case of eggs. 

What effect does an excessive starchy diet produce? 

It may cause obesity; it often produces a form of indigestion known as 
carbohydrate dyspepsia, characterized by gastric fermentation and flat- 
ulence. It may also lead to alimentary glycosuria. 



164 PHYSIOLOGY 

Give the metabolism of (a) proteids, (b) carbohydrates, and 
(c) fats. 

(a) Proteids are acted upon by the pepsin of the gastric juice and con- 
verted into proteoses and peptones. When the chyme reaches the small 
intestine, the trypsin from the pancreatic juice continues the process of 
conversion into peptones. 

(b) Carbohydrates are acted upon first by the ptyalin in the saliva and 
converted into maltose. This action continues for a short time in the 
stomach until it is arrested by the acid reaction, to be resumed again in the 
intestine, where the chyme is acted upon by the amylopsin of the pancreatic 
juice and also by the succus entericus. 

Fats are split up into fatty acids and glycerin and formed into soaps 
and emulsions. This process takes place in the intestine under the influ- 
ence of steapsin from the pancreatic juice, assisted by the bile. 

Into what general classes are foods divided? Give examples 
of each class. 

(1) Inorganic proximate or alimentary principles ; oxygen, water, so- 
dium chlorid, and other inorganic salts. 

(2) Nitrogenous principles — proteids and albumins, meat, eggs, and 
cheese. 

(3) Carbohydrates — sugars, starches, and gums. 

(4) Hydrocarbons — fats and oils. 

(5) Condiments — spices, alcoholic beverages, tea, and coffee. 

What are amyloid foods and proteid foods? Give three ex= 
amples of each. 

Amyloid foods are the carbohydrates, the molecule of which contains 
six or a multiple of six atoms of carbon, and hydrogen and oxygen in the 
proportion to form water. Starch, cane-sugar, and glycogen are amyloids. 

Proteids are highly complex bodies containing carbon, hydrogen, oxy- 
gen, nitrogen, sulphur, and sometimes phosphorus. Egg albumin, casein, 
and gluten are proteids. 

Name the groups of food=stuffs constituting the source of 
muscular energy. Designate the most important and state 
what stored product is utilized. 

Carbohydrates chiefly. Fats and proteids may also aid in the pro- 
duction of muscular energy. 

Glycogen is the stored product that is utilized. 

Name the nitrogenous formative principles. 

(a) Proteids or albuminous constitutents; (b) albuminoids; (c) album- 
inous bodies less complex than albuminoids; and (d) iron-bearing com- 
pounds. 

Name the nitrogenous proximate principles. 

Albuminoids: white of egg (albumin), lean of meat (myosin), casein, 
and gluten of wheat. 

Gelatinoids: Jellies (mucin and rerapin). They are albumin sparers. 

Extractives: They stimulate the upper digestive tract and produce 
appetite. 



What arc peptones? Ho* 1W thc> formed? 

Peptones art- lormnl from proteids I>v the action ol pep in in " I 

juit »• and trypsin iii the nam rr.iiii junc. I he. .He .it. orbed I 

in the Nin.ill intestine .mil are soluble. Hie intermediate produi tis< .died 

Mention three examples Ol ain\loi\l food. Describe in ilc tail 
the chances that amyloid food undergoes in the process of 
digestion. 

Cane sugar, bread, and potatoes. 

The insoluble starch is converted into solul . <Uxtrm t which is 

Liter converted into maltose by the action of ptyaim in the mouth and 

stomach; uncooked starch is converted into maltose by the aim lop -in 

in the pancreatic juice. The dextrin and maltose are later converted 

into glucost by the action of the BUCCU8 entericus. 

What is the function of each class of foods in the nutritive 
process? 

The proteids build up and repair the tissues; the carbohydrates 

are the body fuel, being easily oxidized; the fats are not readily oxidi/ed, 
hut are used to form heat, the excess being stored in the adipose ti 
the salts are necessary to keep some of the proteids in solution, to regulate 
osmosis, to neutralize the acid produced by catabolism, and to form bone. 

What special use does each of the following serve in the body 
after ingestion — proteids, fats, carbohydrates, alcohol, tea, and 
coffee? 

Proteids repair the tissues; fats are used for body fuel and as a reserve; 
carbohydrates are the body fuel; alcohol in small doses is a general stim- 
ulant, and by stimulating the mucous membrane causes an increased 
flow of gastric juice. Tea and coffee are stimulants, increasing the How 
of the various secretions and stimulating peristalsis. 

What are the principal uses of water when taken into the 
body? 

Water is essential to life. It is a constitutent of all tissues and fluids of 
the body, dissolves the food, distributes the nutriment, removes waste 
matters, and conveys them to the organs of elimination. By evaporation 
it aids in maintaining the body temperature. 

Describe the energy or heat=producing value of food prin= 
ciples. 

The unit is the calorie or amount of heat required to raise the tem- 
perature of i kg. of water i° C. The heat value of carbohydrates is 
equal to 4 calories per gram; fats, 8.9 calories; proteids, 4 calories per 
gram. If the relative proportions of alimentary principles in a given 
food are determined by analysis, the fuel value of the food can be 
calculated. 

Mention four alimentary principles essential to health. 

Water, salts, proteids, and one form of fat or carbohydrates. 



1 66 PHYSIOLOGY 

Give the origin of normal fat in the human body and name 
examples of the types of food from which it is elaborated. 

The normal fat of the body is derived mostly from the non-nitrogenous 
moiety of proteids; some from the fat ingested and some from the carbo- 
hydrates. Any excess of food is stored up as fat. 

Describe the physiologic causes of obesity. 

Overfeeding, especially with carbohydrates, lack of proper exercise, 
and certain peculiarities of the body-cells of an individual. 

Does alcohol possess a food action, and on what do you base 
your answer? 

Alcohol is decomposed into carbon dioxid and water, and as it readily 
undergoes this decomposition, it diminishes to a certain degree the con- 
sumption of the constitutents of the body. But it replaces only fat, not 
albumin or carbohydrates (in mixed diet). In small quantities it aids 
digestion and stimulates tie circulation and the nervous system. It 
may supply food in times of temporary privation and protect the tissues 
of the sick from too rapid consumption. 

Describe the disturbances of function produced by the exces- 
sive imbibition of alcohol. 

Excessive imbibition of alcohol causes congestion of the stomach, with 
altered gastric secretion, precipitation of pepsin during gastric digestion, 
congestion of the liver, and, finally, destruction of many of the liver-cells. 
On entering the circulation it acts as an irritant to the whole vascular 
system and to the kidneys. It deranges the nervous system. It also 
lowers the temperature by causing peripheral congestion and consequent 
excessive radiation of heat. 

In a healthy man, what time is consumed in the digestion of 
an ordinary meal of meat, vegetables, and bread? 

About seven hours. 

Describe the digestion in the stomach of a meal of bread and 
milk. 

The conversion of starch contained in the bread into maltose by the 
ptyalin of the saliva continues for some time in the stomach. The proteid 
or gluten contained in the bread is converted by the pepsin into gluten 
peptone. The milk is coagulated and the caseinogen converted into 
casein by the rennin, after which the casein is changed into casein proteose 
and peptone by the action of pepsin. The lactalbumin and globulin are 
also converted into proteoses and peptones. The soluble salts are 
dissolved and the fats are melted. 

Describe in detail each step in the digestion of a meal con= 
taining proteids, carbohydrates, fats, water, and inorganic salts. 

Proteids are digested in the stomach by the pepsin and hydrochloric 
acid, forming albumoses; and by the trypsin of the pancreatic juice into 
peptones. Carbohydrates are converted by the ptyalin in the saliva, 
the amylopsin in the pancreatic juice, and the succus entericus into 



maltose; the I finish th 

the most important fci mcnt. MuIiom- um 
change in ii , lie intotinal v.. ill and In the bio 

banged to fatty adds and . and form <>.i|»>, iritfa i ; 

of steapsin an<l bile. 

\\ atei Is absorbed a-^ su< h In the imall intestine; salt i In the stoma* h 
and in tin- small intestine. The portal vein carries to the liver the 
proteids, sugars, irater, and salts. 

Describe the digestion o! a meal of beefsteak anil potatoes 
Digestion of the proteid contained in the beefsteal 
stomach, where it is converted into albumose (and peptone) by the p 
and hydrochloric arid, and continued in the small intestine by the action of 
the trypsin in the pancreatic juice, which converts the albumose 
peptone From the intestine the peptones enter the blood and are 
carried to the liver, The t connective tissue of fat is digested in the Btonuu h 
ami the fat droplets arc liberated and tlu-n broken up in the small into 
by steapsin into fatty acids and glycerin. With the aid of the bile an 

emulsion is formed and absorbed by tlie Luteals. 

Potato digestion begins in the mouth by ptyalin converting the starch 

into maltose, and is continued in the stomach for about fifteen minutes. 
In the small intestine the amvlopsin of the pancreatic juice, assisted to a 
slight degree by the succus entericus, continues the process, and the 
maltose is still further changed in its passage through the intestinal wall and 
in the blood. 

Salts are absorbed directly in the stomach and small intestine. 

What is the influence of diet on nutrition? 

For nutrition to go on properly, the diet must contain the various classes 
of foods in proper proportion. Proteids and salts are absolutely necessary. 
Nothing but proteids can replace the used-up proteids of the tissue. 
Salts are needed especially to neutralize the acids formed during proteid 
catabolism and to assist in the formation of some of the secretions, like 
the hydrochloric acid of the gastric juice. Calcium salts are indispensable 
for bone formation. 

What is the effect of an excessive meat diet? 

An excessive meat diet disturbs the general metabolism, causing dis- 
eased conditions associated with an increase in uric acid, as gout, rheuma- 
tism, and migraine. 

What would be the effect of an exclusive diet of (a) nitro» 
genous food, and (b) fats and carbohydrates? Explain. 

(a) The breaking down of the digestive apparatus and of the kidneys. 
A man would have to eat 4.41 pounds of meat. 

(b) Destruction of proteids and accumulation of fat in excess, with 
loss of strength, anemia, and diminished resistance to disease. The 
animal becomes fatter, but poorer in flesh. 

What precautions should be taken in the ingestion of vege=» 
table foods? Give the reasons for taking these precautions. 

Vegetable foods should be well cooked so as to burst the cellulose 



l68 PHYSIOLOGY 

covering of the starch granules, and for the same reason mastication must 
be thorough. Some fatty food should be taken with them, as they are 
deficient in fats. As some vegetables contain but little nutritive material, 
they should be taken in relatively large quantities. 

Give the relative food value and ease of digestion of meat, 
milk, eggs, and leguminous fruits. 

According to relative food value, the order is: meat, eggs, milk, and 
leguminous fruits. 

According to relative ease of digestion, the order is: milk, eggs, meat, 
and leguminous fruits. 

What is the composition of human milk? 

Milk contains 112 parts of solid matter to the thousand. Of these, 60 
parts are the carbohydrates, lactose; 30 are fats, olein palmitin, stearin, 
and butyrin; 20 are proteids, casein and lactalbumin; and 2 parts are 
salts, especially sodium chlorid and calcium phosphate. 

Water 87 .4 

Total proteid 2.3 

Fat 3.8 

Sugar 6.2 

Salts 0.3 



100. o 



ABSORPTION 

What do you understand by absorption? 

The process by which certain materials are taken up by the tissues or 
transformed by them into new substances. It is accomplished by means of 
physical and vital forces, the vital being primary and the physical second- 
ary. The physical forces are osmosis, filtration, and imbibition or capil- 
larity; the chief vital force is the selective power of the epithelium of the 
small intestine and other structures, the liver, and lymph-glands. 

Mention the facts and conditions that favor absorption and 
those that retard it. 

Concentration: Salts and sugars are absorbed in larger quantities 
from concentrated than from dilute solutions. The presence of certain 
substances, as salt, pepper, alcohol (stomach), oils, and bile (intestine) 
promotes absorption. Heat promotes, cold retards absorption. Pres- 
sure: Absorption is best when the pressure in the intestinal canal is 
moderate. Increased pressure causes contraction of the blood-vessels 
and retards absorption. Disease: Intestinal disease (cholera) and the 
presence of poisons that injure the epithelium of the intestinal wall retard 
or abolish absorption. 

Define assimilation. 

It is the conversion into protoplasm of the nutrient material or food 
ingested. 



OPTION 

What is meant In diffusion ami osmosis? Give examples 
in the- luiman i\onom\ . 

riir pro< ess by whi< h two uil.tr liqu 

separated by i membrane, effect an Intercl tfaeii *<>n titutent 

parti until l>oth liquids have the same composition. A solid 

also passes through a membrane by endo 010 1 If B liquid capable ol 

dissolving it is present on the other side Endosmosis tatu In the 

alimentary canal through its mucous membrane and toe delicate 
membranes of capillary blood vt els and lymphati( 

/' i : n, or simple mixture, is the Interchange of particle of mi able 
liquids not separated by ■ membrane 

Define endosmosis, exosmosis. 

Bndosmosis is the passage of any liquid through a porous diaphragm 

from without inward. 

Exosmosis is the passage of any liquid through a porous diaphragm 

from within outward. 

\\ hat is meant by endosmotic equivalent? 

The figure which represents the weight of water that passes in endos- 

mosis) while a given weight of the substances passes out (exosmosis). 

What are the channels of absorption? 

The capillary blood-vessels and the lymphatics, especially the lactcals 
in the small intestine. 

Describe the structure of an intestinal villus and show how 
it is adapted for absorption. 

A villus is a projection of all the tissues that enter into the composition 
of the intestinal mucous membrane. It is covered by a single layer of 
columnar epithelium, with intervening isolated goblet-cells. Protoplasmic 
processes resembling cilia extend into the lumen of the intestine like pseu- 
dopods, which seize the finely granular fat (chyle) and draw it into the 
cell body. The villus is provided with capillary blood-vessels and an 
axial or central chyle vessel, the lacteal, surrounded by adenoid tissue 
(Piersol's Histology, page 169). 

Give the general composition of lymph, and explain why and 
upon what circulatory conditions the quantity formed depends. 

A clear, colorless, albuminous fluid, containing lymph-cells and 
white blood-cells. 

The quantity formed depends upon increase in arterial pressure and 
hyperemia of the part after digestion, the quantity of water in the blood, 
and the permeability of the vessel walls. 

Give the origin and uses of lymph. 

Lymph is diluted and modified blood plasma that has escaped from 
the capillaries by osmosis, containing lymph-cells (from the lymphatic 
glands) and white blood-cells. It supplies the tissues with pabulum and 
carries away waste matters. The lymph in the walls of the small intestine 



I70 PHYSIOLOGY 

contains the absorbed fat and is called chyle. The products of some of 
the ductless glands are probably conveyed to the blood by the lymph. 

How does the digested food enter the circulation? 

Through the lacteals (lymphatics) and capillary blood-vessels. 

What agencies induce the flow of lymph to the point of dis- 
charge in the veins? 

The pressure within the tissues (vis a tergo), the contraction of the 
muscular tissue, and the play of the numerous valves in the lymphatics; 
the negative pressure within the thorax. 

Describe the process of absorption by (a) the blood=vessels, 
and (b) the lymphatics. 

The contents of the small intestine pass through the epithelium of the 
villi by osmosis and the vital activity (selective power) of the cells. Water, 
alcohol, salts, carbohydrates, and proteids enter the capillary blood-vessels 
and are carried by the portal vein to the liver, whence they reach the general 
circulation through the hepatic vein. Fats and fatty acids are taken up 
by the lacteals and carried to the receptaculum chyli, from which they are 
discharged into the thoracic duct and enter the left subclavian vein. 

Mention the nutritive fluids of the body and state the functions 
of any one of those mentioned. 

Blood, lymph, and chyle. The last is a modified lymph which passes 
through the lacteals in the small intestine. 
Functions, see page 145 and 162. 

What substances are absorbed principally (a) in the stomach, 
and (b) the duodenum? 

Stomach: alcohol, salt solutions, and, to a less degree, albumoses and 
peptones. 

Duodenum: carbohydrates, fats, albumoses and peptones, glucose, 
water, and salts. 

Give the relative activity of absorption in the alimentary 
canal, the skin, and the lungs. 

Lungs, alimentary canal, and skin, in the order named. 

Define and differentiate secretion and excretion. 

Secretion is the elaboration and separation of certain fluid or semifluid 
substances by glandular epithelium. It is the function of the glands and 
follicles. External secretion: discharge on a free epithelial surface com- 
municating with the exterior. Internal secretion: discharge into the blood 
or lymph (glucose — ductless glands). 

Excretion: the separation of the waste products of an organ, or of the 
body as a whole, out of the blood. 

Name two circumstances influencing secretion. 

Reflex nervous stimulation and an adequate supply of blood to the 
gland. 



1 7 1 

Qrve tlit* etomtntan structure <>t nil secreting ^Innds, and 
dtfCribc the changes thai take place during secretion. 
All M-i reting glands consist of two fundamental p 

portion, tnd iperfidal portion through which the 

•ion reaches the turf ace. During rest the cells of the acini l> 
distended n itli the product of the gland and the Qudd ded to the 

periphery, tftei a< tive ie< retion the cells appeal ihrunken, end th 
toplasm .ind nucleus are more distint t. l he blood supplj reting 

gland i^ increased during it-- activity. 

Define and illustrate (a) simple tubular glands, (h) com 
pound tubular glands, and (c) racemose glands. 

\ rimple tubular gland consists of a single straight or tortuous 
fundus, lined with Bpherical or polygonal secreting epithelium, and an 
excretory duct, the lining cells of which are pnu ti< ally the same as t! i 
the adjacent mucous membrane. Example: peptic glands and glai 
Lieberkuhn. 

(b) In compound tubular glands the fundus is divided into two or more 
slightly expanded divisions opening into a common duct. Example: 

pyloric glands of stomach, kidney, and liver. 

(c) Racemose Glands. — The fundus is represented by a cluster of a< ini 
and the secretion is conveyed by a system of branching excretory ducts 
consisting of the following parts: intermediate tubules, each communicating 
with several adjacent acini; intralobular tubes, interlobular tubes, inter- 
lobular ducts, and excretory ducts, which latter usually unite to form a single 
common duct of large size. Example: salivary glands and pancreas. 

Describe gland secretion as illustrated by the action of the 
parotid gland. 

In response to stimulation of the secretory nerves the epithelial cells of 
the gland discharge their contents into the excretory duct. Glandular 
activity is accompanied by, but not dependent upon increased vascularity 
of the gland. Histologic changes take place in the gland cells during 
secretion, proving that they take an active part in the process. In the case 
of the salivary glands, mucin and ptyalin do not occur in the blood and 
must, therefore, be formed within the gland cells. 

The presence of food in the mouth stimulates the sensory endings of 
the lingual and glossopharyngeal nerves and sends afferent impulses to the 
reflex center in the medulla, which stimulates the motor cells of the cranial 
secretory fibers. The center may also be stimulated through oilier paths, 
the endings of the pneumogastric in the stomach, the uterine nerves, and 
cerebral fibers (the thought of savory viands induces a tlow of saliva). In 
the case of the parotid gland the secretory impulses reach, the gland through 
the nerve of Jacobson or the tympanic branch of the glossopharyngeal. 

Describe an epithelial secreting surface. 

The mucous membrane of the stomach is covered with columnar epi- 
thelium and presents, in addition to the folds or ruga?, the openings of the 
gastric glands, appearing as minute depressions. The mucosa is sup- 
ported on a layer of connective tissue which contains involuntary muscle 
fibers, blood-vessels, and lymphatics (the submucous, muscular, and 



172 PHYSIOLOGY 

serous coats). The glands are entirely contained within the mucous coat. 
(For description of gastric glands, see page 158.) 

Explain the anatomic and physiologic difference between 
mucous, serous, and synovial membranes. 

A mucous membrane is a secreting surface covered with epithelium and 
usually provided with glands. It consists of a connective-tissue stroma or 
tunica propria, a basement membrane or membrana propria, and the epi- 
thelial covering. All cavities and passages communicating with the air are 
lined with mucous membrane. 

Serous membranes form the lining of all cavities cut off from the atmos- 
phere and form part of the lymphatic system. They consist of a single 
layer of endothelial cells resting on a connective-tissue stroma. 

Synovial membranes are modified serous membranes that form the lin- 
ings of the synovial capsules of joints, tendon sheaths, and bursae. They 
secrete a glairy, viscid fluid for the lubrication of opposed articular surfaces. 

Name seven secretions and name the functions of each. 

1. Milk. To provide nourishment for the young. 

2. Saliva (see page 154 and 155). 

3. Gastric juice (see page 154). 

4. Pancreatic juice (see page 154). 

5. Bile (seepage 154). 

6. Sweat. Elimination and heat regulation (see pages 177 and 178). 

7. Prostatic fluid. Dilutes and furnishes motor stimulation to sperma- 
tozoa. 

8. Synovial fluid (see preceding question). 

Name the excretory glands of the body and the function of 
each. 

The kidneys excrete urine; the sweat-glands eliminate waste materials 
in the sweat and help to regulate the heat of the body; the liver disposes of 
some effete matter, disintegrated blood-cells, and certain poisons. 

Through what mediums is the blood relieved of effete matter 
and provided with new material? 

The capillaries and lymphatics both carry away effete matter and 
supply the blood with pabulum. The liver and spleen dispose of the dead 
blood-cells. The lungs provide the blood with oxygen and eliminate the 
carbon dioxid. 

Name the excretions of the body. 

Urine, feces, sweat, and carbon dioxid. 

What physiologic laws are the basis of rectal feeding in 
disease? 

The laws governing digestion and absorption. The large bowel is 
practically without digestive activity, but absorption takes place through 
its walls to a considerable degree, and fluid injected slowly into the rectum 
may at times pass beyond the ileocecal valve. Nutritive enemata should 
be liquid and should contain principally nitrogenous substances — eggs, 



mi i tBO 

milk, and meal predigested by peptonization and by the additj 
pan< reatin. 

METAHOLISM 

\\ hat is metabolism? 

The power possessed hy all li\ i/ed hoilie of Continually U 

up and renew iiu; by ( hemi< al processes the matter compo ing their I 
The process of building up is called onoboHsm 01 a imitation] the pi 
of breaking down cotaholtsm. 

The 0&/« fa of metabolism arc to build up new tissue and repair 
to store up food material and fuel, to transiorm tin- food into beat and 
energy, and to prepare the ezcrementitious matters. The < hi mi 
consist in hydration, dehydration, reduction, and oxidation. 

Name the inorganic proximate principles that enter into the 
formation of the human hotly. 

Water and the various salts, as sodium ehlorid, potassium sulfate, 

calcium fluorid, and magnesium phosphate. 

What do you understand hy the term nutrition, and what 
processes are comprised under it? 

By QUtrition is meant the taking ill of nutrient material, its conversion 
into Living protoplasm, and the throwing off of waste matter from the 

cell. It includes digestion, absorption, metabolism, and excretion. 

What influence has the nervous system on the process of 
secretion? 

The nervous system controls the process of secretion by the various 
secretory centers and nerves, and by regulating the blood-supply of the 
various organs of the body. 

Describe the action of the nervous system on the salivary 
glands. 

The secretion of saliva is controlled by a center in the medulla. The 
efferent (secreto-motor) impulses for the parotid gland are coin eyed by 
the auriculotemporal nerve; for the submaxillary and sublingual glands 
by the chorda tympani. Reflex secretion of saliva may occur through 
stimulation of the afferent nerves in the mouth, stomach, gustatory, 
olfactory, and auditory fibers. 

How are (a) the proteids, (b) carbohydrates, (c) fats, and (d) 
salts utilized in the process of metabolism? 

(a) The proteids are used in building new tissue and repairing loss. 

(b) and (c) The carbohydrates and fats supply most of the heat and 
energy. 

(d) Salts are needed in various ways, especially to combine with the 
sulfuric and phosphorous acids formed in proteid catabolism. 

Describe fat and tell where it is found. 

Fat at the temperature of the living body is a liquid, consisting of 



174 PHYSIOLOGY 

palmitin, stearin, and olein. It is found in adipose tissue, fat-cells united 
by connective tissue, which is widely distributed in the body, especially 
under the skin and around the viscera. 

State the function or functions of (a) bilirubin, (b) hemo= 
globin, (c) myosinogen, (d) fibrinogen, and (e) caseinogen. 

(a) Gives the yellowish-brown color to the bile — a derivative of hemo- 
globin. 

(b) The coloring matter of the blood; conveys oxygen to the tissues. 

(c) A constituent of muscle tissue coagulating at 55 C. and forming 
myosin. 

(d) The soluble albumin of blood plasma. It is converted into 
fibrin by the action of fibrin ferment or thrombin (see page 144). 

(e) A proteid constituent of milk which, when acted upon by rennet, 
produces casein. It is analogous to myosinogen and fibrinogen. 

Describe cholesterin, giving its origin and function. 

Cholesterin is a monatomic alcohol, a normal ingredient of nerve 
tissue, and thrown off in small quantities from the body in bile, being 
a product of disintegration. It is probably a waste product of nerve tissue 
and of the epithelial cells of the biliary passages. 

Define leukomain. 

Leukomains are alkaloidal or basic substances formed in the living 
tissue by metabolism, waste in nature. Some leukomains are toxic. 

What are ptomains, and how are they produced? 

Alkaloidal substances resulting from the decomposition and putre- 
faction of albuminous (animal and vegetable) materials. Some are 
poisons, the greater number are not. Directly or indirectly they are 
dependent upon bacterial activity — "transition products — the process of 
putrefaction," and found in a variety of animal and vegetable foods. 

What is meant by metabolic equilibrium? 

That normal condition in which precisely the same quantity of mate- 
rial is taken up and assimilated from the digested nourishment as is re- 
moved from the body through the excretory organs in the form of waste 
materials or end-products of retrogressive tissue metamorphosis. The 
income must balance the expenditure. 

What becomes of the nitrogen ingested with the food? 

Almost all is excreted in the urine in the form of urea; about 2 per cent, 
as uric acid and creatinin, and from 4 to 5 per cent, in the feces. Traces 
escape with the expired air. 

Mention four necessary constituents of a normal diet. 

(1) Water; (2) salts; (3) proteids; and (4) fat or carbohydrates. 

What proportion of nitrogenous and non=nitrogenous ele- 
ments in the diet is most advantageous? 

One nitrogenous to four parts of non-nitrogenous elements. 









\ M U \ I HIM 

\\h\ is it Impossible for iii.iii t<> subsist on an exclusive mi.it 

diet? 

I obtain the num! ■ ■ • fvsary for his daily i 

would h . i . time a larger quantity ol meat than 

could cope with. 

What is meant In internal secretion? 

The production by certain organ* ol lubetancei that enter the circu- 
lation and inllueiue metaboli&m either by inanufai turin- an anli«:- 
in >oine other unknown manner. 

Mention some of the organs that are thought to furnish an 
internal secretion. 

The adrenal bodies, the thyroid and thymus glands, the pituitary 
. the liver, the kidney-, the tCStU les, and the ovarii--. 

In what glands of the body is the function undetermined? 

Except that they are probably in some way concerned with general 
metabolism, the functions of the following glands are undetermined: 
pituitary body, thymus and coccygeal gland. But little is known about 
the adrenal bodies and thyroid gland. 

Give the physiology of (a) hunger, and (b) thirst. 

Hunger is the constitutional need of the body for food, manifesting 
itself by symptoms referred to the epigastrium. The impoverishment and 
changes in the blood so affect the central nervous system as to cause the 
sensation. 

Thirst is the constitutional need of the body for water, with localized 
symptoms in the pharynx. The lack of water in the blood so affects the 
nervous system as to cause this dryness of the throat. 

ANIMAL HEAT 

What are the sources of animal heat? 

The chemical action involved in the oxidation or combustion of food. 

Muscular and visceral activity (digestion, muscular and mental 

work, and circulation of the blood) are attended by the production of heat. 

Give the normal temperature of the bodv. 

9 8.6° F. 

In the axilla 37° C. 98. 6° F. 

In the mouth 377 . 2 C. 98. q° F. 

In the rectum 38.oi°C. 100 14 F. 

In the vagina 38 03 C. ioo.45°F. 

— (Landois). 

What per cent, of the weight of the body is water? State 
the function of water in the body, and how it is eliminated 
from the body. 

Approximately 75 per cent. Water acts as a general solvent, being 
necessary to secretion and the carrying of nutrition to and the waste 



176 PHYSIOLOGY 

products from the tissues. By its evaporation it dissipates large quan- 
tities of animal heat. 

It is eliminated by the kidneys, sweat glands, lungs and in feces. 

What is the cause of the post=mortem rise of temperature 
sometimes observed? 

Coagulation of the blood and myosin — rigor mortis — and persistence of 
metabolic activity (growth of hair); diminished radiation on account of 
cessation of circulation. 

What conditions produce variations in the normal temper= 
ature of the body? 

Age: Highest in the newborn and aged. 

Season: o.i° to 0.3 C. lower in winter than in summer in the temperate 
zone. 

Climate: Very slightly (0.5 C.) higher in the tropics than in the 
temperate zone. 

Digestion: Increased metabolism and muscular movements of 
viscera cause a slight increase. 

Time of Day: Highest between 5 and 8 p. m. ; lowest between 2 and 

6 P. M. 

Exercise: Causes a slight increase. 

Hemorrhage: Reduces the body temperature from 9.5 to 2 C. 

Venesection: Fall followed by rise and chill. 

Hypodermoclysis and transfusion are followed by a rise of temperature. 

Poisons: Chloroform, chloral, anesthetics, alcohol, digitalis, quinin, 
and acentanilid lower the temperature. Nicotin, strychnin, picrotoxin, 
and veratrum viride cause elevation. 

Shock causes a lowering of the temperature, followed by a reactive rise 
above normal. 

Paralysis is sometimes accompanied by a reduction of temperature. 

Mention some of the conditions affecting heat production. 

Age: Young animals produce more heat in proportion to their weight 
because of the relatively larger body surface and of their greater meta- 
bolic activity (growth). 

Sex: Less in women than in men. 

Species: The smaller the species, the greater the amount of heat pro- 
duced per kilo of body-weight. 

Temperature: Increase of body temperature increases heat production; 
increase of external temperature decreases heat production. 

Digestion: Increases heat production on account of the chemical 
changes and vascular activity involved. 

Drugs: Cocain increases, narcotics lessen heat production. 

How is normal body temperature regulated and sustained? 

It is regulated chiefly by the nervous mechanism of heat or thermotaxis. 

There are thermogenic and thermolytic centers. The principal thermo- 
genic centers — automatic, reflex, or general — are found in the cord, prob- 
ably in the anterior horn. The thermolytic centers are five in number: 
vasomotor, sweat, respiratory, cardiac, and pilomotor. Dissipation of heat 



II- M 

ti effected by dilatation of thi 

acceleration ol the respiration, .mm t the i thehaii • 

animals). Sweating Is probably the moat Important factor In heal 
Minion. (Foi Heat Prodiu tfo) 

what variations <>t" temper a ture are found In the d i fferent 
puts of the body? Mention the reasons for mkIi variations. 
The highest temperature is found in tin- blood of tin- hepatfc vein ai 

due to the amount oi luat formed iu the liver. I he tip ol the no 

to be the coldest part of the body, due to its expo tion ;m<I to the 

thinner of its walK The skin is always cooler than the internal Ol 
partly on account of the radiation of heat from tin- bloo 

and partly on account of tlu- increased heat production in tlu- internal 
organs, 

State the functions of epithelium. 

Absorption, protection, secretion, and the reception of nervous im- 
pulses. 

FUNCTION OF rHE EXTERNAL INTEGUMENT 

Mention the glands of the skin and give their functions, 
i. Sebaa - . Secrete sebum, which keeps the epidermis and hair 
pliable and prevents maceration and excessive desiccation. Varieties of 

sebum: remix cascosa, covering the body of the newborn; preputial 
smegma; eerumen (ear-wax); and the secretion of the Meibomian glands 
(cutaneous fat). 

2. Sudoriferous. Secrete sweat (see last question on this page;. 

What are the functions of the skin and its appendages? 

i. Integumentary and protective. It protects the underlying ti 
against undue pressure and external mechanical injuries. The pn 
exerted on the cutaneous vessels prevents excessive loss of lluid from these 
vessels. When dry, the skin is a poor conductor of electricity. It pre- 
vents the absorption of poisons and keeps adjacent parts from growing 
together. The hairs serve as tactile organs — eyelashes and lanugo hairs 
of the face. Being a poor conductor, the hair of the scalp, besides affording 
protection against rain and external mechanical injuries, assists in 
lating animal heat by taking up and giving oil heat, and affords protection 
against direct radiation from the sun. 

2. The respiratory function of the skin is of minor importance. About 
one-sixty seventh of the body-weight is lost through the skin, mostly by 
evaporation of water. Some carbon dioxid is excreted, and about an 
equal quantity of oxygen is absorbed. The skin excretes only one- two 
hundred and twentieth as much carbon dioxid as the lungs, and absorbs 
about one-eightieth of the quantity of oxygen absorbed by the lungs. 

3. Secretory (see next question). 

(a) What matters are excreted by the skin? (b) How may 
the functions of the skin be affected as to the amount of e\cre= 
tion? 

(a) Water, carbon dioxid, nitrogen in the form of urea in the sweat, 



178 PHYSIOLOGY 

and in desquamated epidermal structures (hairs and nails) ; sodium chlorid 
and other alkaline chlorids; and traces of sulphur. 

(b) (1) Factors that increase the secretion of sweat: (a) elevation of 
surrounding temperature; (b) ingestion of water, especially hot water; (c) 
muscular and cardiovascular activity (nitrogen also increased) ; (d) eleva- 
tion of body temperature; (e) certain drugs: pilocarpin, physostigmin, 
strychnin, picrotoxin, nicotin, and camphor; and (f) stimulation of the 
sweat center, as by the presence of carbon dioxid in the blood, by over- 
heating the blood, and by poisons. 

(2) Factors that diminish or suppress the secretion of sweat: (a) cold and 
very high temperatures — above 50 C. (122 F.); (b) increased urination 
and defecation (dry skin in diabetes; development of uremic state in 
cholera). 

What is the composition of sweat? 

Water, 991 parts in 1000; solids, 8.5. Organic: neutral fats — palmitin, 
stearin, cholesterin; volatile fatty acids; formic, acetic, butyric acid; 
traces of albumin; urea (0.1 per cent.); uric acid; and ammonium salts. 
Inorganic: sodium chlorid, potassium chlorid, sulfates; traces of earthy 
phosphates and sodium phosphates; and carbon dioxid and nitrogen. 

What are the uses of perspiration? 

1. Excretion of certain substances. 

2. Heat regulation by evaporation. 

3. Keeps the skin moist. 

State the use and importance of (a) perspiration, (b) bathing. 

By the evaporation of perspiration the body is kept at a regular tem- 
perature. The perspiration carries off waste products and keeps the skin 
pliable. 

Bathing cleanses the external surface, stimulates the function of the 
skin, and increases the general tone of the body. 

What relation does the nervous system bear to the excretion 
of perspiration? 

The secretion of sweat is controlled by (a) vasomotor and (b) sweat 
fibers. As the two kinds of fibers pursue almost identical paths, increased 
sweating is usually associated with vasodilation. After division of the 
cervical sympathetic, unilateral sweating is observed. The sweat centers 
in the medulla, which probably have the same distribution as the vaso- 
motor centers, may be irritated by overheating of the blood; the accumula- 
tion of carbon dioxid; and the presence of other poisons in the blood; 
irritation of sensory nerves; excessive heating of the skin; stimulation of 
gustatory fibers (localized sweating on the forehead and under the eyes 
after eating acid substances). 

MOTOR APPARATUS 

Describe the structure of (a) striated muscle, and (b) non= 
striated muscle. Which of these is voluntary and why? 

(a) A striated muscle is covered by a connective-tissue sheath, the exter- 



•n whi< h end Into I 

form the :«.vr »/.;.' /'•" ing vrssds .iii«! nerves and divi 

the imiM le Into bundle! of fibci . I he Indh [dual fiben, varying In l< 
and thickneai from 5.3 t»> 0.8 cm, and 10 to 10 . 

in a structureless, transparent sheath, the uircolemma t ami exhibit ' 

at Inten iii <>t' a to 1 v- In addition then b ■ longitudinal 
■triation due t<> the fad thai the fiber is made up of Dumeroui del 
primitive fibrils. Each separate fibril is striated transversely and all are 
bound together by 1 cement substana — wcopUum. The fibril has 
1 columnar structure an«l la made up «>f numerous must ular dement 
perposed In layers. Muscle fiben contain Beveral longitudinal Dudd iur- 
rounded by ■ thin layer of sarcoplasm and called muscle cof\ 

or tWO nucleoli are found in each nmlcus. 

Striated musdc Ifl called voluntary because it is under the control of 
the will. 

(b) XottstripcJ or smooth muscle consists of small, unicellular, spindle- 
shaped libers not surrounded by sareolemma and exhibiting faint, ! 
tudtnal, hut no transverse striation. The fiben are .sometimes forked 
(heart) and the rod-shaped nucleus is situated at the center of the fiber. 

Name some of the involuntary muscles and the function with 
which each is concerned. 

The uterus is the organ for the carrying of the developing embryo and 
fetus. The muscle is used for the expulsion of the fetus at the end of 
intra-uterine life. 

The muscular wall of the intestine is used for mixing and passing on 
the food received from the stomach. 

The tunica media of the arteries contains many muscular fibers that 
control the supply of blood to the various parts of the body. 

Describe the changes in form, volume, and physical and 
chemical properties occurring in the contraction of a muscle. 

The muscle becomes shorter, but the volume remains the same. It 
becomes acid in reaction, more oxygen is used up, and more carbon dioxid 
given off; glycogen is used up, and the muscle substances soluble in water 
are diminished, while those soluble in alcohol are increased. 

Define (a) tonic muscular contraction, and (b) clonic mus- 
cular contraction. Give an example of each. 

A tonic muscular contraction is continuous, as the action of the sphinc- 
ter ani and other sphincter muscles. 

Clonic muscular contraction is intermittent or remittent, like the jerking 
movements in a (clonic) convulsion. 

What stimuli produce muscular contraction? What is the 
nervous mechanism of muscular contraction? Illustrate. 

Stimuli producing muscular contraction are: normal (voluntary), chem- 
ical (automatic movements), thermal (reflex excitation), mechanical, and 
electric. 

Nervous median ism of muscular contraction. The motor impulse 
starts from the motor nerve-cell, passing down the motor neuraxon to the 



l8o PHYSIOLOGY 

motor end-plates, where the muscle-cells are stimulated to contract. One 
stimulus would simply cause a muscular twitch, but normally in a muscu- 
lar act a series of impulses is sent from the nerve centers to keep the mus- 
cles in a voluntary tetanus. Example: In raising the foot the motor im- 
pulse starts in the cerebral gray cells of the Rolandic area, passes down to 
the cells in the anterior horn of the opposite side in the lumbar cord, then 
out through the sciatic nerve to the motor end-plates of the muscles re- 
quired to lift the foot, which in turn stimulate the muscular fibers. 

Define electrotonus, and explain the law of contraction 
operative when a closing and opening current is applied to the 
muscles. 

If a living nerve is traversed throughout a definite length by a con- 
stant electric (polarizing) current, the muscle passes into a condition of 
altered irritability designated electrotonus. At the positive pole or anode 
the irritability is diminished and anelectrotonus prevails. At the negative 
pole or cathode it is increased — catelectrotonus. 

i. On closing the circuit stimulation occurs only at the cathode at the 
moment when catelectrotonus develops. 2. On opening the current 
stimulation takes place only at the anode at the moment when anelectro- 
tonus disappears. 3. The stimulus attending the development of catelec- 
trotonus is stronger than that caused by the disappearance of anelectro- 
tonus. 

What is meant by the condition of tetanus in a muscle? 

When a muscle goes into a state of continued contraction it is said to be 
tetanized. 

Give the causes of muscular fatigue. 

Accumulation in the muscular tissue of the products of metabolism or 
fatigue bodies, which are formed as a result of muscular activity — phospho- 
ric acid, acid potassium phosphite, and carbon dioxid. Fatigue can be 
removed by washing away the substances by the passage of normal salt 
solution or the injection of arterial blood into the vessels. An animal may 
be fatigued by transfusion of blood from a completely fatigued animal. 

What is rigor mortis? 

Rigor mortis is the post-mortem rigidity of the muscles due to the coag- 
ulation of the myosin in the muscle fibers, with the production of heat and 
lactic acid. 

Give the function of the epiglottis. 

Assists in preventing the entrance of food into the larynx during deglu- 
tition and influences the timbre or quality of the voice (clear or muffled) ; it 
does not affect pitch. 

Describe the position of the vocal cords during phonation and 
name the factors concerned. 

The chink of the glottis during phonation is narrowed, the arytenoid 
cartilages are approximated, and the vocal cords are stretched. The 
arytenoid muscle approximates the arytenoid cartilages and, with the help 



of the lateral cri d the internal part of the thj 

1 be \<» il I l roidi 

and external part of the thyro trytenoida. 

Define stammering and itate what caueei it. 
Stammering la a defect of speech due to the spasmodic action of the 
diaphragm interrupting the flow of air past tin- vch al « orda. 'I he I 

ami lips arc under COntTOL 

Define aphonia ami aphasia. Give the cause of one of these 
conditions. 

I Is the! of voice or power of phonation. [t is due to paral- 

. the motor nerves of the larynx, wounds, tumors, anrury>m, rheuma- 
tism, overexertion, hysteria, or edema of muscles. 

Aphasia is the inability to give the proper word symbol Motor 
aphasia is due to a lesion of the left lower frontal convolution or of the 
fibers coming from it. 

What is the location of the center for articulate speech? 

The center for articulate speech is in tirocas convolution, the left lower 
frontal in right-handed people. 

How are the vocal sounds produced? 

By vibration of the true vocal cords in the larynx, brought about by the 
current of expired and, under certain circumstances, inspired air. The 
modifications of the voice are effected by the peculiarities and arrangement 
oi the cavities above the larynx — the mouth, pharynx, and nasal cavities — 
which act as M reinforcing tubes. " 

THE SECRETION OF URINE 

Describe the function of the kidneys. Do both kidneys act 
constantly? Explain. 

The function of the kidneys is to remove from the blood water and 
certain waste substances, especially urea and uric acid, which pass out of 
the body in the urine. The secretion from the two kidneys is not constant 
or uniform, the condition is one of alternation between activity and hyper- 
emia. One kidney may secrete urine containing a large quantity of water, 
salts, and urea, and of a higher degree of acidity than the secretion of its 
fellow. Extirpation or functional loss of one kidney does not diminish the 
secretion, as the other kidney undergoes compensatory enlargement and its 
activity is increased to supply the extra demand on the secretory structures. 

How does impairment of the function of the kidneys affect 
that of the skin and lungs? 

The activity of the sweat-glands is increased and the excretion may con- 
tain urea and uric acid. The odor of the breath becomes urinous; dysp- 
nea, asthmatic attacks, and, at times, Cheyne-Stokes breathing and pul- 
monary edema develop. 



1 82 PHYSIOLOGY 

Give the minute structure of the kidney. 

The kidney is a compound, tubular gland consisting of an outer portion 
or cortex, and a central striated portion, or medulla, occupying two- 
thirds of the gland. The cortex contains the Malpighian bodies, each of 
which consist of a convoluted mass of capillary blood-vessels, the glomer- 
ulus, and the surrounding capsule of Bowman. The glomerulus has an 
afferent artery and an efferent (arterial) vessel. The uriniferous tubules 
begin in the cortex as the capsules of Bowman and terminate as the excre- 
tory ducts or tubes of Bellini in the papillae of the medullary portion. 
Their orifices are recognizable by the naked eye. The uriniferous tubules 
undergo several changes in size and shape during their tortuous progress 
through the kidney substance, the successive portions being: capsule of 
Bowman, neck, proximal convoluted tubule, spiral portion, descending 
limb, Henle's loop, ascending limb, irregular tubule, distal convoluted 
portion, arched collecting tubule, straight collecting tube, excretory duct 
or tube of Bellini (see Huber's Histology, page 323). 

State the function of (a) the vas deferens, (b) the vesiculse 
seminales, and (c) the prostate gland. 

(a) The vas deferens is the excretory duct of the testicle. 

(b) They act as reservoirs for the seminal fluid, to which they con- 
tribute a secretion of their own. 

(c) The prostate gland, a musculoglandular organ, secretes a thin, 
milky fluid which assists in diluting the seminal fluid and probably fur- 
nishes to the spermatozoa the motor stimulation essential for impregnation. 
In its character as a muscular organ it acts as an involuntary sphincter 
of the bladder. The prostate is also thought to produce an internal 
secretion. 

Describe the renal circulation. 

The renal artery enters the kidney at the hilus and at the juncture of 
the cortex and medulla divides into the cortical branches and the arterix 
rectce, which supply the tissues of the medullary portion. The cortical 
arteries supply the afferent vessels of the glomeruli, which form the groups 
of convoluted capillaries characteristic of these structures. The glome- 
rular capillaries unite to form the efferent vessels (conveying arterial blood) 
which, after leaving the Malpighian bodies, break up into a second set 
of capillaries surrounding the convoluted tubules. These capillaries are 
taken up by the interlobular veins, which pass to the pelvis and aid in 
forming the large renal veins. The blood from the peripheral portions 
of the cortex is collected by the stellate veins and also escapes from the 
kidneys in the renal veins. 

State the influence of the blood circulation on the secretion 
of urine. Explain the effect of division of the renal nerves on 
the secretion of urine. 

Increased cardiac activity, causing increased blood-pressure and 
velocity of the current, augments the quantity of urine; stimulation of the 
vasomotor center has the same effect. Conversely, weak heart action 
(myocarditis, valvular lesions) and vasomotor paralysis diminish the 



uritia: >n. If the i: blood pn \ all -uniin 

may pasa Into the urine. 

Division ol the renal nerves, which ba 

followed I •<-ment of the renal VeStell and in* rra-ed urination or 

polyuria. It" the iiu rcu>e in pre^ure i ilhuniinurj 

and rupture ol the globular veateli may be followed by hematuria. 

State the accepted theory regarding the mechanism of the 
secretion of urine. 

The Mvretion i^i urine depends partly 00 the blood pressure and partly 

on the functional activity ol the epithelium lining the urinary tubule 
the glomeruli. The urinary water is principally in the glomeruli, 

and its quantity depends chiefly <>n the bl< ire; the me* Enc urinary 

BObatancea (urea) are removed from the blood by the epithelial cellfl of the 

convoluted tubules. \o secretory nerves have been demonstrated in the 
kidneys, which seem to be controlled by the vasomotor system. 'I here is 
some evidence that the kidneys also possess an internal secretion. 

Describe the physical properties of healthy urine. 

A straw-colored or amber, clear liquid, acid in reaction, with a specific 
gravity of 1015 to 1025. The taste is saline and bitter, the odor charac- 
teristically aromatic or "urinous." A slight sediment collects on standing. 

Give the variations within the limits of health in the specific 
gravity of urine. 

1002 to 1040. The minimum is observed after copious drinking, the 
maximum after profuse sweating and great thirst. 

Give the normal constituents of the urine. 

Water. Organic: urea, uric acid, creatinin, alloxuric bodies, and 
hippuric acid. Inorganic: sodium chlorid, potassium, and sodium .sul- 
fates, indican (conjugate and ethereal sulfates), earthy and alkaline phos- 
phates, acid phosphates, sometimes carbonates and oxalates (calcium). 
Coloring matters: urobilin, urochrome, uro-erythrin, and uromelanin. 

What conditions increase the amount of solids in the urine? 

Physical exertion, increased ingestion of salts, fewer, diarrhea, free 
perspiration, limiting the quantity of tluid ingested (relative increase), 
and diabetes mellitus (1030 to 1060). 

Describe urea, its occurrences, variations in the quantity 
excreted, and recognition in the voided urine. 

Urea, CO(XH 2 ) 2 , is a crystallizable substance soluble in alcohol and 
water, almost insoluble in ether, and neutral in reaction. Urea occurs 
in the liver, the principal seat of its formation; the intestines; also the blood, 
lymphatic glands, spleen, lungs, brain, etc. The daily quantity is from 
30 to 40 gr. (between 2.5 and 3.2 per cent.), and varies with the amount 
of nitrogenous food in the diet and the disintegration of the nitrogen- 
containing tissues in the body. It is increased also by exercise. 



184 PHYSIOLOGY 

How is uric acid developed in the human system? What 
class of foods increases the development of uric acid. 

From the nuclein of the disintegrating leukocytes. In general all 
nuclein-containing foods, such as cheese, salt fish, or salt meat. 

Where is the vesical center located? 

The vesicospinal center for reflex stimulation of the smooth muscle of 
the bladder is situated in the spinal cord, in the neighborhood of the 
fourth lumbar vertebra. 

Describe the mechanism of micturition. 

Irritation of the sensory nerves of the bladder, when it is moderately 
distended, excites in the vesicospinal center the reflex through the motor 
nerves of the bladder, which causes contraction of the walls and expulsion 
of the contents, after the sphincter of the urethra has been voluntarily 
inhibited. Evacuation is aided by voluntary contraction of the abdom- 
inal muscles, and in men, toward the end of the act, of the bulbocavernosus 
muscle (accelerator urinae). The reflex may also be excited by irritation 
of other sensory nerves (tickling or warming the region of the knee, hear- 
ing the sound of running water). 

THE NERVOUS SYSTEM 

Define life and death. 

Life is the sum total of vital activities — (a) sustentative, (b) correla- 
tive, and (c) generative. Death is the cessation of all vital activities. 

Give a physiologic explanation of (a) sleep, and (b) dreams. 

(a) When the potential energy in the nerves, especially the central 
organs, has been consumed, restitution becomes necessary and sleep is 
induced probably by the accumulation of decomposition products in the 
body. 

(b) Toward the period of awakening, the psychic activities may 
reappear in the form of dreams, consisting either of hallucinations, 
visions without any objective cause, or perverted volitional impulses or 
conceptions. 

What is the condition of the brain during sleep? 

The brain during sleep is in a condition of partial anemia, the general 
blood-pressure being lowered. All psychic activities are abolished. 

Enumerate the physiologic advantages of natural sleep and 
state at what period of life the least sleep is required. 

(a) The fall in the blood-pressure and the relaxation of the vasomotor 
tone, aided by the recumbent position, insure the most complete rest for 
the heart. All the tissues of the body, especially the nervous tissues, have 
an opportunity to recuperate, and waste matter is carried off. 

(b) It is during adult life that the sleep is least required. 

Describe nerve=cells and fibers. 

Nerve-cells or neurons are nucleated masses of granular protoplasm, 



mi NEBVO 

with ■ prolon fcfo I 

nerve i eU i are supplied \\ itfa .1 long fibo • 

Nerve fibers are medullated 01 nonmedullata 

( 1 1 The fibers are lurroun 

beatb ol Schwann. They are moat numerous in the sympathetfc 

i e ■ ■■ white fibers axis i j linden 01 ae 

surrounded by myelm or the white substance ol Sen i called 

medullary sheath), which in turn is covered by the sheath in or 

neurilemma. They are found principally in tin- cerebrospinal w 
Sere and there under the sheath ol Schwann arc found tin- nod 

annular constrictiona about which the myelin is wanti 

Define (a) afferent, (b) efferent, (c) trophic, (d) Inhibitory, 
and (e) motor and vasomotor nerve fibers. 

(a) One carrying impulses to the central nervous system from 
various parts ol the body. The optic nerve carries impulse 

on the retina to the brain. 

(b) One carrying impulses from the nerve-cell to the various part- of 
the body. The facial nerve carries motor impulses from the correspond- 
ing center in the brain to the muscles ol expression. 

Nerves influencing the nutrition, metabolism and growth ol the 
s to which they are distributed. Lesions involving destruction of 
the trophic nerves and centers cause atrophy of the corresponding t: 
(muscles, cartilage in joints, and hones). 

(d) Nerves carrying impulses which tend to suppress or diminish a 
movement or secretion already present. 

(e) Nerves carrying motor impulses from the brain or cord to the 
various muscles of the body. 

(f) Xerxes carrying impulses which control the muscular tone of the 
walls of blood-vessels. 

Describe the action of the vasomotor nerves. 

The vasomotor nerves contain pressor (vasoconstrictor) and depressor 
(vasodilator) fibers. Irritation of the pressor fibers causes stimulation 
of the vasomotor center in the medulla and increased tone in the 
blood-vessels (vasomotor tone). Irritation of the depressor libers causes 
reflex diminution of the irritability of the center. The vasomotor nerves 
serve to regulate the blood-pressure and the amount of blood going to a 
part; they also contribute to the regulation of the body temperature by 
increasing and diminishing evaporation from the surface. 

Define reflex action and give examples. 

Action resulting from an afferent impulse, followed by an efferent 
impulse, without the intervention of the higher cerebral centers. Reflex 
action is independent of the will. Examples: Tapping the tendon of the 
quadriceps extensor is followed by a reflex contraction of the muscle 
(knee-jerk). The pupils contract under the influence of light and ac- 
commodation. 

Explain the physiologic circuit essential to a reflex action. 

A centripetal fiber, a ganglionic nerve center in the gray matter, a 



1 86 PHYSIOLOGY 

centrifugal fiber (cord or medulla), and muscle or other peripheral organ 
supplied by the efferent nerve. This is called the reflex arc. 

Mention (a) the superficial reflexes, and (b) the deep reflexes. 

(a) Abdominal, cremasteric, plantar, palpebral, palatal and corneal 
conjunctival. 

(b) Knee-jerk or patellar reflex, ankle-clonus, bicipital reflex, chin 
reflex, and pupillary reflex. 

What is the physiologic significance of the normal patellar 
reflex and through what nerves is it accomplished? 

Health: it is present in all but about 5 per cent, of normal individuals. 
Afferent path: posterior root of fourth lumbar nerve; efferent path: fourth 
and fifth lumbar nerves. 

What is ankle=clonus? 

A vibratory movement of the foot obtained by supporting the tendo 
Achillis with one hand while the foot is strongly flexed with the other. 
It is rarely obtained in health, but is often marked in hysteria and in 
lateral sclerosis. 

Give illustrations of morbid reflex action. 

The vomiting of pregnancy is caused reflexly by irritation of the mucous 
membrane of the uterus. Faulty digestion may cause reflex palpitation 
of the heart. 

Mention (a) special sensations, and (b) common sensations. 

(a) Sensations of pressure, temperature, muscular sense, and locality, 
(b) Pain, itching, tickling, and the feelings due to electric stimulation. 

How is the sensation of pain produced? 

Stimulation of the special endings of the pain nerves in the skin, or 
stimulation of the trunk of the nerve causes an impression to be sent to 
the special area of the brain presiding over pain sensations. Stimulation 
of this center results in the subjective sense of pain. 

Describe the origin of a tear as the result of pain. 

The pain causes reflex stimulation of the lacrimal gland, followed by in- 
creased secretion. More secretion is produced than can be carried off by 
the lacrimal canal and the excess overflows from the conjunctival sac as 
tears. 

Describe the arrangement of the sympathetic nervous system. 

It consists of (a) a pair of gangliated cords, which are placed on the 
front and sides of the vertebral column, and (b) three great prevertebral 
plexuses: the cardiac plexus, contained in the thoracic cavity; and the solar 
and hypogastric plexuses in the abdominal cavity. The anterior branch 
of each spinal nerve gives off a visceral branch — communicating branch 
of the sympathetic — and these visceral branches collect to form the 
sympathetic chain. In the thoracic portion there is a ganglion at the point 
where each visceral branch enters the sympathetic; in the cervical portion 



1 1 u RttVQ 

[ghth tnd the leventh, and alao the ifarth .m< l the fifth •• 
rep res ented i»> tingle ganglia, tnd th<- four uppef cervical j die 

superior cm ngtio*, Each gas connected to the correspond* 

Ing spinal nerve by two rami < ommunu ■:> rhite and The 

white consists of mniullatrd fibers, which enter th<- ganglion and pass 
through it toward tin- viscera, rhe jray ramui communis 

': tnidulUittd fiben and passes baCI from tin- ganglion t«> join the 

spinal nerve, giving oil afferent libers, which enter th<- spinal cord, and 
which join the spinal nerve, formii "tor and pilo- 

motor nerves and nerves to the sweat-glands In the skin. 

(iive the varied functions of the sympathetic nerve* 
Vasomotor, secretomotor, pilomotor, innervation of the inda, 

acceleration of the heart, inhibition, and motor control of the) 
Sympathetic fibers also control the movements of the iris — dflatati 

the pupil. 

What are the functions of the main sympathetic ganglia? 
Dilatation of the pupil (cervical ganglion), regulation of the heart action 

(automatic ganglia of the heart), control of the movements of the in- 
testines, and digestive processes (abdominal ganglia). 

State the effect of (a) stimulation of the cervical sympa- 
thetic nerve, (b) Section of the cervical sympathetic nerve. 

(a) Dilatation of the pupil (mydriasis). 

(b) Contraction of the pupil (miosis). 

Define nerves of special sense. 

The nerves of special sense are the nerves carrying the afferent im- 
pulses from the various peripheral sense organs — eye, ear, nose, taste- 
buds, and tactile corpuscles — to the central nervous system. 

(a) What three cranial nerves are for special sense? (b) 
What six are exclusively motor? (c) What three are com= 
pound? 

(a) Olfactory, optic, and auditory. 

(b) Oculomotor, trochlear, abducens, pneumogastric, spinal acces- 
sory, and hypoglossus. 

(c) Trigeminal, facial, and glossopharyngeal. 

What is the function of the first cranial nerve? 

It is the nerve of smell. 

State the function of the nervus opticus, and explain by 
description or diagram the distribution of the fibers composing 
the chiasm and the effect thereof upon vision. 

The nervus opticus is the nerve of the special sense, sight. At the 
chiasm the inner half of each optic nerve crosses to the opposite side; 
therefore, in loss of function of one optic nerve, from injury or pressure 
back of the chiasma, there is blindness of the temporal side of retina of 
the same eye and of the nasal side of the opposite eye. 



1 88 PHYSIOLOGY 

State the functions of the fifth cranial nerve. 

The fifth nerve is the sensory nerve of the face, mouth, teeth and nasal 
cavities, and the motor nerve of the muscles of mastication. 

Give the physiologic properties of the facial nerve. 

The facial nerve is the motor nerve for the muscles of expression of the 
face and controls the secretion of the salivary glands. Through the fibers 
of the chorda tympani and the lingual nerve it also subserves the sense of 
taste in the tip and margin of the tongue. The gustatory fibers of the 
chorda tympani originate in the glossopharyngeal nerve and enter the 
facial through the intermediary portion of Wrisberg. 

What would be the effect of paralysis of the seventh cranial 
nerve (portio dura) on the right side? 

Paralysis of the right half of the face. 

Name the functions of the chorda tympani, sufficiently 
detailing each to clearly define its character. 

The chorda tympani contains sensory (also tactile and thermic) and 
gustatory fibers for the anterior portion of the tongue; secretory fibers for 
the sublingual and submaxillary glands; and vasodilator fibers for those 
glands and for the anterior two-thirds of the tongue. 

What is the function of the glossopharyngeal nerve? 

The glossopharyngeal is the nerve of taste for the posterior third of the 
tongue and the lateral portion of the palate. It supplies motor fibers to 
the stylopharyngeus muscle; secretory fibers to the parotid gland. It is 
the sensory nerve for the posterior third of the tongue, the tonsils, the 
anterior palatine arches, the soft palate, and a portion of the pharynx. 

What are the functions of the pneumogastric nerve? 

Among its many functions the pneumogastric is motor and sensory to 
the larynx; motor to the pharynx and esophagus; motor, sensory, and 
secretory to the stomach; inhibitory to the heart; motor and sensory to the 
lungs; and sends some filaments through the sympathetic system to the 
pancreas, liver, and intestines. 

Give (a) number of spinal nerves, and (b) function of an- 
terior and posterior roots. 

(a) Thirty-one. 

(b) Motor and sensory, respectively (Bell's law). 

State the function of the anterior spinal nerve=roots. How 
is the function proved? 

They supply motor fibers to all the striated voluntary muscles of the 
trunk and extremities and to certain organs, the bladder, uterus, and skin ; 
vasomotor fibers to the vessels; sweat fibers to the sweat-glands; and trophic 
fibers. Section of the anterior roots causes motor paralysis of the parts 
that they supply. Irritation of the peripheral ends causes contraction of 
the muscles they supply. Irritation of the central ends has no effect; no 
sensation is felt. 



Describe the functions of spinal iur\o. 

The spinal d iv the afferent and efferent Imp 

tnd of the back of the bead t<> and from the central nervoti 
Among the efferent Impulses are tho tperarure, tai die, 

and muscular sense Among the efferent are the motor, trophic, 
secretory, and vasomot 

What arc the functions <>t the spinal cord? 
The spinal cord is the great motor and sen iory path* ay to and from the 
periphery, in the anterior horns are found the cells coi In the 

muscular reilexes and also the trophic centers for the mu des. B 
the muscular reflex renters, the cord contains the folio 
anospinal, vesicospinal, genitospinal, uterospinal, sweat, minor \ 
and possibly ciliospinal. 

Explain the functions of the principal columns of the 

spinal cord. 

The anterior and lateral columns — the pyramidal tracts — convey motor 
impulses to the voluntary muscles of the same side. Sensation, pain im- 
pressions, sensation o\ heat and cold, and muscular and pressure sen- 
sations are conveyed through the posterior columns. 

What are the respective functions of the anterior and of the 
posterior cornna of the spinal cord? 

The anterior eornua are motor in function and contain the trophic cen- 
ters for the muscles. The posterior eornua are mostly relay stations on 
the sensory pathway. 

Where is the respiratory center? 

The respiratory center is situated in the floor of the fourth ventricle, 
between the nuclei of the vagus and spinal accessory nerves. 

Name the principal centers of organic function in the medulla 
oblongata. 

Respiratory, cardio-inhihitory, cardio-accelerator, vasomotor; centers 
for salivation, mastication, deglutition, vomiting; and diabetic center. 

Describe the offices and the characteristics of the gray matter 
of the brain. 

The gray matter of the cerebral cortex is arranged in six alternate gray 
and white layers, the most important of which is the deep gray layer of 
large pyramidal cells. The gray matter of the cerebrum is the center i^r 
sensation, volition, and ideation; that is, it receives the sensation, sends 
out all voluntary impulses, and is the part of the nervous system in which 
thought goes on. 

What differences of function exist between the white and the 
gray matter of the encephalon? 

The gray matter is composed of cells which are the terminals that 
receive sensation, classify the knowledge thus received, and send out im- 
pulses. The white matter is made up of libers that transmit the impulses 
connecting the cells with each other and with the periphery. 



190 PHYSIOLOGY 

What portion of the cerebrum comprises the motor area? 

The motor area is found along the fissure of Rolando, in the ascending 
frontal, ascending parietal, and paracentral convolutions, and contiguous 
parts of the superior frontal. 

From what portions of the cortex cerebri do the arm, face, 
and leg receive their motor impulses? 

The fissure of Rolando in the ascending frontal, ascending parietal, and 
paracentral convolutions. The leg center is the uppermost, the arm 
center next, and the face center the lowermost. 

Locate in the brain the seat of the special sense of sight, 
hearing, and smell. 

Sight has its seat in the gyrus angularis, cuneus, and in the occipital 
lobes; hearing in the superior temporal convolution; and smell in the uncus. 

What is the function of the cerebellum? 

The function of the cerebellum is the co-ordination of muscular move- 
ments. It also provides voluntary movements with sufficient strength and 
increases the tone of the muscles during rest. 

What are the functions of the brain membranes? 

The dura mater is tough and protects the brain. It also supplies the 
place of an internal periosteum to the bones of the head. The arachnoid 
is a thin, spider-like membrane covered with endothelial cells that secrete 
cerebrospinal fluid. The pia mater is a vascular membrane dipping down 
into the sulci and carrying blood to the cortex. 

ORGANS OF SPECIAL SENSE 

Name the organs of the special senses. 

The eye, the ear, the upper portion of the nasal cavities, the taste- 
bulbs on the tongue, and the tactile end-organs. 

Describe the different coats of the eye and give the functions 
of each. 

i. External or fibrous coat, formed by the sclerotic and cornea, consist- 
ing of fine connective-tissue fibers. The cornea is transparent, the sclera 
white and opaque. The sclera is almost avascular, except for a large 
venous sinus at the corneal junction — the canal of Schlemm. The cornea 
contains no blood-vessels except at its periphery; by virtue of its trans- 
parency, it admits the rays of light, and by its convexity takes part in the 
refractive mechanism of the eye. The sclera is the protecting coat of the 
eyeball. 

2. Middle or vascular coat containing the uveal tract, iris, ciliary 
body, and choroid. The choroid forms the posterior part of the tract 
and contains pigment and blood-vessels. In front of the choroid is the 
ciliary body, which also contains blood-vessels, and the ciliary muscle, 
the muscle of accommodation. The anterior part of the uveal tract is 
formed by the iris, which acts like a diaphragm by cutting off the margi- 
nal rays and regulating the amount of light that enters the eye. 



PI I [Al 191 

Internal or tt>> the raMwfl. 'I lini the I 

, or nemo epithelium, which arc sensitive to lij 

Name the refracting media of the eye and the effect thai each 

has on the ra\s of li}iht. 

I he eomea, tqueOUi humor, crystalline lens, ami vitreous I- 

They all converge the raya of light In the following order of pot 
crystalline lens, ntreom body, aqueous humor, and cornea. 

DeacribC the Crystalline lens and state its relations and func- 
tions. 

1'hc fata is I biconvex, transparent body endoted in a hyaline, elastic 
Capsule. The posterior surface is more convex than the anterior. The 

lens is suspended within the globe by a suspensory ligament, it 

Zinti, attached to the capsule and BWUng from the ciliary processes. 'Die 
outer portion or cortex is softer than the central portion or nucleus, whit h 
is quite dense. The lens comes in relation in front with the aqueous 
humor and pupillary border of the iris; behind with the anterior surface of 
the vitreous, which receives it in a cup-like depression; peripherally, by the 
suspensory ligament, with the ciliary region. The crystalline lens is the 
organ of accommodation and refracts the different rays of light by altering 
its convexity. 

What are the functions of the iris? 

The iris is a circular muscular membrane or curtain with a round 
central opening. Its functions are: (1) to cut off the marginal rays like 
the diaphragm in a microscope and thus render vision more distinct; (2) 
to regulate the amount of light that enters the eye by contracting under 
strong illumination and relaxing (dilating the pupil) when the light is 
feeble; and (3) to assist the action of the muscle of accommodation. 

Account for the contraction and dilatation of the pupil. 

It is a reflex phenomenon regulating the amount of light that enters the 
eye and sharpening the image for near vision. The iris contains two sets 
of fibers; circular or contracting (sphincter iridis), and radiating or dilating 
(elastic) fibers. 

Of the functions of vision, what is understood by accommo- 
dation? 

The act of increasing the curvature of the anterior surface of the crys- 
talline lens to focus near objects on the retina. 

How is accommodation in the eye accomplished? 

At rest, the lens is held flat against the vitreous body by the traction of 
the stretched zonule of Zinn, w r hich is attached to its margin. When the 
ciliary muscle contracts to focus for near objects, it draws the margin of 
the choroid forward, and the zonule, which is in intimate relation with it, 
is relaxed and allows the lens, by virtue of its elasticity, to assume a more 
convex form (it becomes thicker). The posterior surface does not take 
part in the increase of curvature. 



192 PHYSIOLOGY 

Define myopia, hypermetropia, and astigmatism. State the 
cause of each condition. 

Myopia is a visual defect in which parallel rays of light are focused in 
front of the retina. The usual cause is an increase in the length of the 
anteroposterior diameter of the eye. 

In hypermetropia parallel rays of light are focused behind the retina. It 
is generally caused by a shortening of the anteroposterior diameter of the 
eye. 

Astigmatism is an error of refraction in which rays of light in the vari- 
ous meridians cannot be united at a single point. The rays that pass 
through the vertical meridian come together first, while the rays passing 
through the horizontal meridian are brought together in a more posterior 
plane {regular astigmatism). The error is generally due to irregularities 
in the curvature of the cornea, sometimes of the lens. 

What is the condition of the eye in myopia? How may it 
be corrected? 

In myopia the eyeball is longer than normal and the rays of light are 
brought to a focus in front of the iris. The error can be corrected with 
a concave lens. 

Describe the rods and cones of the retina. 

The rods and cones, visual cells or neuro-epithelium, form the external 
coat of the retina and are separated from the choroid by pigment. They 
are absent at the entrance of the optic nerve. The rods are more numer- 
ous than the cones (5 to 1), but are absent in the macula lutea, where cones 
alone are present. The outer portions of the rods contain a red pigment, 
the visual purple. The cones are shorter than the rods and contain no 
purple. The rods and cones are the only parts of the retina that are sen- 
sitive to light and constitute the active, receptive organ of sight. 

How are the sensations of color produced? 

(1) According to one theory the nervous elements of the retina are 
uniform in type, but are affected in different ways by variously colored 
lights, depending on different wave-lengths in the vibrations of ether, 
rapidity of vibration, and refractive exponent. 

(2) The Young-Helmholtz theory assumes the existence of three 
different sets of retinal fibers, corresponding to the primary colors. Stim- 
ulation of the first set produces the sensation of red ; of the second, green ; 
and of the third, violet. Stimulation of any two sets of fibers produces the 
impression of a mixed color; the stimulation of all, the sensation of white. 
The cones alone are supposed to be concerned in light perception, the rods 
merely with the power of distinguishing between quantitative sensations 
of light. 

Describe color blindness and name the colors which the 
subject commonly fails to distinguish. 

The inability to recognize certain colors, usually red and green. 

Locate the visual center. 

The exact location is in dispute, but the weight of evidence is in favor 



Of tli <>r Upper portion of the* occipital ' 

an* probably present in the external geni< ulate body, the pul-.in.ir o! ih<* 
optic thalamus, an«l the luperior corpus quadrigeminum. 

Qlve the mftchnniffm of the organ of hearing. 

The sound vraves arc collected by tin- auri< le or externa] c.ir and i 
veyed through the external auditory meatus to the membrana tymp 

which divides the meatus from the middle \ chain of 

minute the auditory ossicle — moUtu . —occupy 

the middle car and conned the drumhead with the internal - 
sound waves impinging upon the drumhead Bd up vibrations in 
brane, which arc transmitted by tin- chain of ossi< les to the endolymph of 
tlic Labyrinth of the internal car. These vibrations In the endolymph are 
transmitted to the organs ofCorti % which are contained in the scale media 
oi the interna] ear and form the Bpei ial receptive apparatus of hearing, 
kuditory impressions are then conveyed to the auditory (enter in the 

Cerebrum by the cochlear branch Of the auditory nerve. 

Hon is the sensation of sound conveyed to the brain? 

Through the cochlear branch of the auditory nerve to the medulla, 
thence to the superior olive and, through the lateral fillet and posterior 
quadrigeminal bodies, to the auditory center in the superior temporal 

convolution. 

What is the function of (a) the external ear? (b) Of the 
auditory canal? 

(a) The function of the auricle is insignificant; it probably assists in 

collecting the sound waves, hut its loss is followed by only slight diminution 
in the acuteness of hearing. 

(b) The auditory canal conducts the sound waves to the tympanic 
membrane. 

Describe the olfactory apparatus. What part of the olfactory 
apparatus is the seat of smell? 

The upper portion of the nasal cavities contains the nerve endings of 
the olfactory nerve. These are specialized cells provided with small, 
hairdike processes. From these cells the olfactory nerve passes through 
the olfactory bulbs to the cerebrum, ending in the uncus of the same side. 

What conditions are necessary for properly exercising the 
sense of smell? 

The odoriferous substances must be volatile, the air in the nasal cavi- 
ties must be in motion, and the olfactory apparatus must be in a normal 
condition. 

What nerve supplies the posterior third of the tongue with 
taste and sensation? 

The glossopharyngeal is the gustatory nerve for the posterior third of 
the tongue; sensor}- and tactile fibers are supplied by the lingual nerve, 
a branch of the trifacial. 

*3 



194 PHYSIOLOGY 

Name and locate the papillae of the tongue. 

Circumvallate papillae near the base of the tongue, in two rows, forming 
a V, seven to twelve in number. Fungiform papillae situated in front of the 
circumvallate and irregularly distributed on the dorsum, sides, and tip of 
the tongue. Filiform papillae, thickly scattered over the entire organ in 
front of the circumvallate. 

What nerves are concerned in taste? 

The lingual nerve, & branch of the fifth cranial, supplies gustatory fibers 
to the tip and margins of the tongue. The gustatory fibers are obtained 
from the chorda tympani, which are given off to the tongue as the nerve runs 
in the lingual. They originate in the glossopharyngeal nerve. The glosso- 
pharyngeal supplies gustatory fibers to the posterior third of the tongue, 
the lateral portion of the soft palate, and the glossopalatal arch. 

What nerves supply the teeth ? 

The fifth cranial, or trifacial, through its second and third {maxillary 
and mandibular) divisions. 

Describe the nerve arrangements on which the sense of touch 
depends. 

The tactile fibers contained in the sensory nerve trunks and their ter- 
minations; the tactile corpuscles of Meissner in the skin (corium); the 
corpuscles of Vater and Paccini in the subcutaneous tissue; Krause's 
longitudinal end bulbs in the conjunctiva, the floor of the mouth, lips, 
nasal mucous membrane, etc. 

DEVELOPMENT 

Describe the physiological process involved in the loss of the 
deciduous teeth. 

The pressure caused by the crown of the erupting permanent tooth 
stimulates to activity the odontoclasts in the pericementum, with the 
consequent abortion of the root of the temporary tooth. After the ab- 
sorption has in this manner weakened the attachment of the temporary 
tooth to its membranes, it is shed. 

What are the functions (a) of the enamel? (b) the dentin? 
(c) the cementum? (d) the pulp? 

(a) To cover and protect the dentin; (b) to support the enamel and 
protect the pulp, and to form the body of the tooth; (c) to protect the root 
portion of the dentin and assist in the attachment of the tooth; (d) the 
pulp is the remains of the dental papilla, whose function is the formation 
of the tooth. It ceases formative action when the tooth has reached 
normal size. Through the pulp the tooth is vitalized, the fibrilke extend- 
ing into the dentin through the dental tubules. 

State the approximate time of eruption of the temporary 
teeth. 

The lower central incisors are the first to appear, about the seventh 
month, and are shortly followed by the upper central and lateral incisors. 



DEVEU 

The hitter erupt about the ninth month, i afl about 

the a war. Ilie canines, appearing between the < hand 

twentieth months, and the -<•< ond, or "second-year" molai en the 

twent) fourth and thirtieth months, complete the 
which has do bi< uspids. 

Describe the process <»t .segmentation of the- n\um. 

The OVUm, Immediately alter impregnation, undergor> indirect divi- 
sion or koryokmesis t resulting in the formation of two < ells, whi< h again sub- 
divide to form four cells, and bo on. ( taring to more rapid development 
of some of the cells, the primary single layer subdivides into two lay* 

inner or entoderm, and an outer, called ctodirm, and Mirroundr 
former. Later a third layer, t! < ';;:. i- formed between the 

derm and entoderm. 

Describe the fetal circulation. 

The peculiarities of the fetal circulation arc due to several factors: 
i. The presence ^i a placenta, which supplies the functions <>f the lungs. 

2. The ductus roiosus, a communication between the umbilical vein and 
the inferior cava. 3. The patency of the foramen ovale, connecting the 
two auricles. 4. The uninflated condition and small size of the fetal 
lungs. 5. The ductus arteriosus, extending from the beginning of the 
pulmonary artery to the descending aorta. 

The placental blood (arterial) is conveyed by the single umbilical vein 
to the under surface of the liver, where the current divides, one part enter- 
ing the portal vein, the other passing directly into the inferior cava with- 
out traversing the liver. On entering the right auricle the column of 
blood from the inferior cava (chiefly arterial) is directed by a membranous 
fold, the Eustachian valve, through the for a men ovale, into the left auricle 
while the blood from the superior cava (venous), crossing this stream at a 
right angle, passes through the right auriculoventricular orifice and tills 
the right ventricle. The two currents practically do not mix. From the 
left auricle, which also receives the small quantity of (venous) blood re- 
turned from the uninflated lungs by the pulmonary veins, the current 
passes through the left auriculoventricular orifice into the left ventricle, by 
the contractions of which it is propelled into the aorta and its branches, 
and distributed to all parts of the body. 

The blood from the superior cava (venous), which has entered the 
right ventricle, is forced into the pulmonary artery, and a small portion 
enters the lungs, as in the adult; the greater portion, however, is conveyed 
directly to the aorta by the ductus arteriosus, which extends from the 
beginning of the left pulmonary artery to the aorta. In the aorta it 
mingles with the blood coming from the left ventricle; part of this supplies 
the lower extremities of the fetus, while the greater portion is carried back 
to the placenta for oxygenation by the hypogastric arteries. 

What are the Wolffian bodies? When do they appear and 
into what organs do they ultimately develop? 

The Wolffian bodies are transient excretory organs in the fetus, the 
forerunners of the kidneys. They appear about the eighteenth day, and 
by the fourth month have become atrophied. Portions of the Wolffian 



196 PHYSIOLOGY 

bodies in the female develop into the parovarium, and in the male into the 
vasa eflerentia (coni vasculosi), and parts of the epididymis and vas 
deferens. 

Give the process of development of the parietal bone. 

The parietal bone develops by "intramembranous bone formation' ' 
from an earthy spot in the outer layer of the dura mater. The center of 
ossification corresponds to the parietal eminence. The cells of the osteo- 
genetic layer of the membrane, as in the formation of periosteal bone, are 
arranged along the surfaces of the periosteal fibers and become surrounded 
by the bone matrix, which is derived from the cells. The matrix gradually 
thickens and lacunar are formed, within which lie the osteoblasts, which 
have now become the star-shaped bone corpuscles. Hardening of the 
matrix later takes place through the deposition of lime salts, principally 
phosphate and carbonate. The process is practically the same as that 
of periosteal bone formation. 



PATHOLOGY 



What is understood in the terms pathologic physiology, 
pathologic morphology, special pathology? 

Pathologic physiology is thai branch of science which deals frith the 
study oi disturbancea of function in disease. 

Pathologic morphology is that branch oi science which deals with the 
study of the structural changes in dis< 

Special pathology deals with pathologic processes in individual <>r 
special diseases, organs, oi parts. 

Define oral pathology. 

That branch oi science which deals with disturbances of function 
or structure in diseases of the oral cavity. 

Define (a) etiology, (l>) morbid anatomy, (c) diagnosis, (d) prognosis. 
(a) The study oi the causes of disease. 

(f>) The same as pathology (see first question). 

(c) The identification of a disease by clinical and laboratory mean-. 

(d) An opinion in regard to the course, duration and termination of 
a disease. 

State what is meant by (a) the predisposing cause of disease, 
(b) the exciting cause of disease. 

(a) Any condition which lowers the general vitality, (b) The im- 
mediate or specific condition or agency which produces the disease. 

Describe the incisions necessary to expose the brain for ex- 
amination postmortem. 

An incision is made through the scalp from ear to ear and the flaps 
dissected forward and backward. The cranium is divided by a circular 
incision with a saw, passing through a point 3^ inches above the bridge 
of the nose and through the occipital protuberance, and the dura mater 
cut through with a knife; or the skull-cap may be wrenched off with a 
stout hook, without dividing the dura mater. The falx is divided between 
the anterior lobes, and the membrane drawn back. 

Describe in detail the usual mode of making a postmortem 
examination of the brain. 

The anterior, middle, and posterior cerebral, basilar, and carotid 
arteries having been examined for emboli, thrombi, atheroma, and aneur- 
ysm, the two halves of the cerebrum are separated, exposing the corpus 
callosum, which is divided by a longitudinal incision down to, but not 
through, the ventricle. The incision is then prolonged backward and 
forward so as to expose the cornua. The hemispheres are divided by a 

197 



198 PATHOLOGY 

number of longitudinal incisions, from the lateral ventricles nearly to the 
pia, into a number of prism-shaped pieces, held together by a thin layer of 
cortex. The fourth ventricle is opened by a longitudinal incision through 
the vermiform process, each cerebellar hemisphere divided by an incis- 
ion through the upper and inner convex border and subdivided by further 
incisions in the same direction. The cerebral ganglia are explored by 
making a series of thin transverse sections, commencing in front, and 
finally the same procedure is applied to the medulla. 

What conditions favor putrefaction? What conditions may 
prevent putrefaction in dead organisms? 

Heat, moisture, and the presence of bacteria. Putrefaction is retarded 
or prevented by absence of moisture, cold — conditions inimical to bac- 
terial growth — or by chemical agents. 

What postmortem changes occur in the tissues. 

Cadaveric lividity or hypostasis; putrefactive changes (greenish dis- 
coloration); cooling (algor mortis); rigor mortis; formation of adipocere; 
petrifaction. 

Discuss cell=division and growth. 

Cell-division takes place in two ways: (a) direct or amitosis, and (b) 
indirect or mitosis (karyomitosis, karyokinesis) . Indirect division is 
accomplished by certain complicated changes in the filamentary sub- 
stance of the nucleus, called chromatin or mitome. Three phases are 
described: 

1 . Concentration. The chromatin substance, arranged in the form of 
U=shaped loops, is gathered into a contorted coil, called spireme, and the 
nuclear membrane disappears. The centrosome divides and the segments 
pass to opposite parts of the cell (polar bodies). The threads of the 
spireme break across and form the chromosomes. In man the number 
is said to be 16; according to some authorities, 32. The figure is now 
called the mother star or monaster. 

2. Longitudinal splitting of the chromosomes. Each chromosome splits 
lengthwise into exactly equal parts, which separate into groups and col- 
lect around the two polar bodies forming the diasters or daughter stars. 

3. Division of the cell body and formation of new nuclei about the 
daughter chromosomes. The centrosome may disappear or remain in 
the cytoplasm beside the new nucleus. A nuclear membrane is formed 
and two independent cells, each with a nucleus, are produced. 

Name the more common tissue alterations that accompany 
fever and explain why. 

Increased oxidation and tissue waste resulting in increased heat-pro- 
duction. The quantity of nitrogen excreted in the urine exceeds that con- 
tained in the food, and emaciation results. The specific gravity of the 
blood is increased, and the alkalinity is reduced by various acids produced 
in the increased tissue-destruction. These changes are due in part to the 
increased temperature and in part to toxins circulating in the blood. The 
muscles, heart, liver, and kidneys are the seat of cloudy swelling, fatty 
degeneration, and coagulation necrosis, probably due to toxins. 



\. n\ i BYP1 SI mi v i | j 

What is the cause <>i" a rise- in temperature? Explain the 

met. Maoism. 

In mn.si i i cs fr\ <■ i'«l hy the |>n 

blood acting upon the heat renters. Thcw MiliMames may U- hai 
POfaong, metabolic products, such as allnimoM-s <>r peptone , or ferments 

- pepsin, fibrin ferment, dis Rare!) fever is due to direct exp 

to heat. ,i> in sunstroke, in w hit h, however, toxin produced snd 

effect the heal centers secondarily; or to dired action on tin- centei 
in hysteria. 

Describe the pathologic conditions In hectic fever* 

An infectious or suppurative process somewhere in tin- body. 
most common bacterial causes are pyogenic micro-organisms and B. 
tuberculosis. 

What disease of the mother may he transmitted to the fetus? 
Small-pOX, measles, syphilis, typhoid fever, pneumonia, tubercul 
malaria. 

Enumerate the most ordinary senile changes that occur in 
the various tissues of the body. 

Atrophy ami loss of elasticity of the skin; arteriosclerosis; atrophy of 
the heart and interstitial myocarditis; increased deposition of lime salts 
in the bones and tendons; ankylosis and deformity of the joints. 

Name some of the causes of active hyperemia and give illus- 
trations. 

i. Mechanical (a blow), thermic (extreme heat or cold), and chemical 
(drugs, atropin internally, iodin locally) agencies acting on the muscular 
coats of the arteries. 

2. Nervous influences, either stimulation of vasodilators — neurotonic 
hyperemia — or paralysis of vasodilator nerves — neuroparalytic hyperemia. 
Migraine furnishes a clinical example. 

3. Obstruction in the circulation of a neighboring organ or part — 
collateral hyperemia. Example: obstruction of one renal artery produces 
hyperemia of the other kidney. 

Describe hypertrophy and give its etiology and pathologic 
anatomy. 

An increase in the size of a tissue or organ independent of the general 
growth of the organism. Hypertrophy may be true or functional (com- 
pensatory), or false (pseudohypertrophy). 

True hypertrophy affects both parenchyma and interstitial tissue; the 
outline is preserved, and function is increased. The cause is increased 
functional demand either direct — pregnancy; or indirect, owing to im- 
perfect action of another organ — compensatory enlargement of one lung 
when the other is diseased. False hypertrophy affects the connective 
tissue chiefly or exclusively, the parenchyma usually atrophies, the shape 
and consistency of the organ are altered, and function is diminished. 
Examples are hypertrophic cirrhosis of the liver, pseudohypertrophic 
muscular paralysis. 



200 PATHOLOGY 

Causes: Increased functional activity. Congenital disposition. In- 
termittent pressure (corns, callosities on the palms) . Trophic disturbances 
in certain nerve lesions. Functional disturbance of some of the ductless 
glands — the thyroid, thymus, pituitary body (acromegaly). 

Define atrophy. Give the varieties of atrophy. 

A diminution in the bulk of one or more of the component parts of an 
organ, with diminution of functional activity. The varieties usually 
described are: simple, due to defective nutrition — general, or defective 
blood-supply — local; senile (physiologic); atrophy from disuse; pressure 
(constant, as the pressure of an aneurysm on bone) ; neuropathic, due to 
loss of trophic influences in paralytic affections. The last is a degenera- 
tive process. Brown atrophy occurs in chronic congestive states, especially 
in the heart and liver. 

DEGENERATIONS 

State the difference between degeneration and infiltration. 
Illustrate. 

Infiltration consists in the deposition in the cell of an abnormal sub- 
stance or of a normal constituent in excess; the nucleus and cytoplasm are 
not destroyed. Degeneration is the conversion of the cytoplasm into an 
abnormal substance; the nucleus and cytoplasm are destroyed. (See 
below, Fatty Degeneration and Fatty Infiltration.) 

a. Define fatty metamorphosis, b. Give its terminations. 

(a) The conversion of the cellular protoplasm into fat. 

(b) Liquefaction; caseation; total destruction of cells or necrobiosis. 

Differentiate fatty infiltration and fatty degeneration. 

In the former the fat is deposited in the cell, crowding the nucleus to 
one side without destroying it, and distending the cell. The fat appears 
in large droplets. In fatty degeneration the cytoplasm and the nucleus 
are converted into fat and the cell eventually becomes a sac filled with 
fatty detritus. The fat appears in the form of granules or very small 
droplets. 

Discuss fatty degeneration, explaining of what it may be a 
symptom when affecting parenchymatous cells. 

A retrograde metamorphosis in which the proteid elements are con- 
verted into fat. The cells are completely filled with fat-granules and 
droplets; the nuclei are destroyed. Fatty degeneration occurs chiefly in 
the liver, kidney, walls of the blood-vessels, and myocardium (fatty heart). 
The causes are diminished blood-supply, fevers, and poisons which inter- 
fere with oxygenation. It occurs in the anemias, the cachexia of cancer, 
tuberculosis and syphilis, hypertrophy of the heart with insufficient 
blood-supply (local anemia), in fevers, yellow fever, and in cases of poison- 
ing with phosphorus, bichlorid of mercury, arsenic, carbon monoxid, iodo- 
form, etc. 



I'l I 20I 

Qtve ■ general explanation oi the pathology of cdonu ind 

iiu iiuU- ii*> ^ Me! fa tofti 

Infiltration of the 
fluid. 

The we: I > > obstnu don <>f the veins and rymphat 

es in the composition oi the blood (anemia); < \) disturb*] 
metabolism; (4) changes in the blood dU. 

The < •'•■"•'< oJ ire: heart dia of the 

of the kidneys, anemia, cancerous and tuben ulous < u hexia, oervou 
turbances (hysteria). 

(ii\e the causes of edema. 
See prei ious question. 

Define the term general anasarca and give a nOM patho- 
logic description of the lesion which usually gives rise to it. 

Serous infiltration of the general subcutaneous connective :■' 
throughout the body. 

TOmc parenchymatous nephritis. — The kidney is large, flabby, and 

pale; the capsule strips readily; the cut surface presents a mottled appear- 
ance, yellow areas of tatty degeneration alternating with red, hemorrhagic 

ana-. The kidney of chronic parenchymatous nephritis is called the 
large white kidney. 

Name the albuminoid degenerations. 

Amyloid, hyaline, mucoid, and colloid. 

Describe amyloid degeneration and state in what cases and 
in what organs it is found. 

Amyloid degeneration or infiltration affects chietly the intima of small 
blood-vessels and is characterized by the formation of an albuminoid 
substance giving a characteristic reaction in the cells and intercullar sub- 
stance. The most frequent seats are the liver, kidney, and spleen (sago 
spleen), walls of the intestines, heart, and large blood-vessels, nervous 
system, and prostate gland. The cut surface of organs has a waxy or 
bacony appearance. It is still under dispute whether the proce- 
degeneration or an infiltration, and whether it ever affects parenchyma 
cells. 

How would you recognize amyloid degeneration? 

Iodin and sulfuric acid applied to amyloid material give the amyloid 
reaction, which consists in a blue color. With Lugol's solution a reddish- 
brown color is produced, contrasting with the yellowish or greenish 
brown of the healthy tissues. 

What glands are most frequently affected by amyloid degen= 
eration? 

Liver, spleen, kidneys, prostate, and lymph-glands. 

What varieties of degeneration may occur in lymph=glands? 

Hyaline, amyloid, and fatty degeneration; calcareous and pigmentary 
infiltration. 



202 PATHOLOGY 

Hyaline degeneration — give its etiology and seats. 

A degeneration affecting connective tissue, especially the walls of 
blood-vessels, with the production of a material resembling amyloid but 
not giving the same reactions. Causes: old age; acute infectious diseases; 
chronic inflammation (sclerosis); tumors (cylindromata). Seats: The 
blood-vessels of the brain, kidney, heart, ovary, and lymph-glands. 

What is fibrinous degeneration? 

Synonymous with coagulation necrosis (q. v.). 

Necrosis — distinguish between the coagulation and lique- 
faction forms, with example of each. 

Coagulation necrosis is characterized by the production of fibrin, the 
fibrin-ferment being supplied by the broken-down cells. Example: The 
diphtheritic or "false" membrane in diphtheria. 

In liquefaction necrosis the intercellular substances break down and 
form fluid or pus, the cells floating in the fluid ; no coagulation takes place. 
This form is often the terminal stage of other forms of necrosis. Ex- 
amples: Acute softening of the brain after embolism; the vesicles following 
a burn. 

a. What is mucoid degeneration? b. What is colloid de= 
generation? 

(a) The conversion of epithelial cells (mucoid degeneration) and con- 
nective tissue (myxomatous degeneration) into a viscid substance con- 
taining mucin. 

(b) The conversion of epithelial cells into a gelatinous material which 
resembles mucin but does not give the same reactions. 

Mucin is insoluble, but swells in water; it is precipitated by alcohol and 
acetic acid. Colloid material does not swell in water and is not precipitated 
by alcohol and acetic acid. 

Discuss (a) caseation; (b) calcification. 

(a) A process similar to coagulation necrosis, due to invasion of the 
tissue by the tubercle bacillus. It affects both cells and intercellular sub- 
stance, which are converted into a formless mass of granular — so-called 
cheesy — debris, surrounded by nuclei in various stages of degeneration, 
and an inflammatory zone. The process terminates in liquefaction and 
absorption, or calcification and encapsulation. 

(b) The deposition in tissues other than bony tissue of earthy salts, 
chiefly the carbonates and phosphates of calcium and magnesium. Cal- 
cification occurs in tissues with deficient blood-supply and is found chiefly 
in cartilage; the connective tissue of blood-vessels (aorta, valves of the 
heart, especially the aortic); tumors; encysted parasites; necrotic foci; 
infarcts ; thrombi and emboli (phleboliths) ; ganglion cells of the nervous 
system; and in the form of biliary, renal, vesical, and intestinal calculi 
(enteroliths). 

What is calcific metamorphosis? 

The transformation of cells into a calcareous or mineral substance. 



Till. BLOOD 203 

THE BLOOD 

Define anemia, hyperemia. 

Anemia — any reduction in the quantity or quality of the blood, affect- 
ing the cellular elements or hemoglobin or both. 
Hyperemia — an excess of blood in a part. 

What pathologic changes take place in the blood-plasma? 

Hypertonicity — increased salinity; hyperinosis and hypinosis — increase 
and decrease in the fibrin-forming substances; hydremia and anhydremia 
— increase and reduction in quantity of water in the blood; lipemia — the 
presence of free fat; melanemia — the presence of pigment; hemoglobine- 
mia, methemoglobinemia — the presence of hemoglobin in solution in the 
plasma. 

In what general respects do "anemia" and "progressive per- 
nicious anemia" differ? 

The term anemia properly includes all conditions in which the blood is 
impoverished, but is generally used to designate simple or secondary 
anemia. Pernicious anemia is a primary anemia characterized by oligocy- 
themia and terminating in death. 

What condition of the blood is generally prominent in all 
forms of rheumatism? 

Simple or secondary anemia and leukocytosis. The coagulability is 
increased — hyperinosis. 

How are secretions affected in anemia? 

The urine may be diminished or increased in quantity and also in its 
solid constituents. Hydrochloric acid in the stomach is increased in chlo- 
rosis, but diminished or absent in pernicious anemia. 

Name some of the changes which occur in extravasated 
blood. 

1 . Coagulation, followed by absorption of the fluid elements and depo- 
sition of blood-pigment, which is also eventually carried off by the lym- 
phatics. The tissue destroyed by the hemorrhage is replaced by connec- 
tive tissue. 

2. Organization — the coagulated blood is replaced by fibrous tissue. 

3. Cyst formation — instead of being absorbed, the fluid portion may 
remain as a cyst. 

4. The blood, especially in serous cavities, may become infected and 
undergo suppuration. 

5. Calcification (rare). 

What is ischemic paralysis? 

Loss of power in a part from local anemia. The blood-supply to the 
nerves of the part is abolished. 

WTiat is an embolus? Mention frequent sources of emboli. 
State the sequels of embolism. 

Embolism is the obstruction of a blood-vessel by an embolus or frag- 
ment of fibrin derived from a thrombus. 



204 PATHOLOGY 

Fragments of tissue, tumors, particles of fat, air-bubbles, and micro- 
organisms may also act as emboli. 

The sequels depend on the kind of artery affected. Embolism of a 
terminal artery gives rise to anemic or hemorrhagic infarct; embolism of a 
large artery may lead to gangrene of the part supplied; if the blood-supply 
to the motor area of the brain is obstructed, paralysis results; if the em- 
bolus is infected, a metastatic abscess develops at the site of lodgment. 

(a) What is a thrombus? (b) What is thrombosis? (c) 
Describe the three changes that may take place in a thrombus. 

(a) A coagulum or clot in a blood-vessel remaining at the site of its 
formation. 

(b) Thrombosis is the coagulation of the blood within the vessels or 
heart during life. 

(c) Organization — new connective tissue grows into the thrombus 
from the walls of the blood-vessel. Calcification — Liquefaction — the for- 
mation of a reddish, puriform fluid in the interior of the thrombus. 
Infection — the thrombus may become infected by bacteria and suppurate 

Mention the difference between an embolus and a thrombus. 

An embolus is a particle of fibrin which separates from a thrombus and 
lodges in some part of the circulation. A thrombus is a clot forming 
within a vessel, and is stationary. 

Where are emboli most frequently found? Of what are 
emboli most frequently made? 

In the lungs and brain. Emboli most frequently consist of fibrin 
derived from a thrombus. 

Define infarction, and name the organs in which infarction 
most frequently occurs. 

An infarct is a wedge-shaped infiltration of blood within an organ, due 
to obstruction, usually by an embolus or thrombus, of the artery supplying 
the area affected. Infarcts are most common in the lung, kidney, brain, 
and spleen. 

Give the causes of hemorrhage. 

i. Direct injury from without — traumatic hemorrhage. 

2. Causes residing within the body — essential, autogenous hemorrhage 

(a) Increased blood pressure — whooping-cough (conjunctival hemor- 
rhage), hemoptysis, cirrhosis of liver (esophagus, stomach, intestines, 
hemorrhoids); mitral stenosis (epistaxis, hemoptysis). 

(b) Diseases of vessel-walls — atheroma and aneurysm; arteritis and 
phlebitis; infectious diseases (yellow fever, hemorrhagic small-pox). 

(c) Change in the composition of the blood — anemia, hemophilia, 
embolism of an artery causing hemorrhagic infarction. 

(d) Nervous disturbances — hysteria (bleeding from the hands and 
feet) ; in apoplexy, hemoptysis and hematemesis have been observed. 

What is meant by hemorrhage by diapedesis? In what 
conditions does it occur? 



INFLAMMATION 205 

Gradual escape of the blood through the walls of a Mood-vessel without 
rupture. It occurs in conditions associated with disease of the blood 
vessels, such as poisoning, various infectious diseases, hemophilia, scurvy, 
and the like. 

INFLAMMATION 

Explain the difference between congestion and inflammation. 

Congestion is an excess of blood in a part, either active, due to causes 
enumerated above (see page 199), or passive, due to venous obstruction. 

Inflammation is a complicated process consisting in overfilling of the 
blood-vessels (hyperemia), the exudation of serum, the escape of leuko- 
cytes through the altered vessel-walls, and the proliferation of connective- 
tissue cells. It is the reaction of the tissue to an irritant. Active hyper- 
emia is the first stage of inflammation. 

What are the four cardinal indications of inflammation? 

Redness, swelling, pain, and heat. 

(a) Describe, in their order, and explain the cardinal signs 
of inflammation and (b) state the terminations of inflammation. 

(a) Redness, due to overfilling of the blood-vessels. Swelling, explained 
by engorgement of the vessels and the escape of plasma and blood-cor- 
puscles through the vessel-walls. Pain, due to pressure by the swollen 
tissues on the nerve-endings or the action of irritant products (bacterial). 
Heat, probably from increased heat-production due to active chemical 
changes. 

(b) Resolution, regeneration or suppuration, necrosis, or some form of 
degeneration. 

What histologic changes occur in acute simple inflammation? 

1. Momentary contraction of capillaries, followed by dilatation. 2. 
Formation of new capillaries and contraction of the cells between the 
capillaries. 3. Retardation or even stasis of the blood-current. 4. Pe- 
ripheral drift of the leukocytes. 5. Exudation of modified plasma and 
emigration of leukocytes, and sometimes diapedesis of red blood-cells, 
through the altered vessel-walls. 6. Swelling of the tissues — inflammatory 
edema. 7. Proliferation of connective-tissue cells and probably of 
leukocytes; or degenerative changes in these cells. 

Describe catarrhal inflammation. 

Inflammation of mucous membranes. The mucosa and submucosa 
are congested and edematous; there is an abundant serous, mucous, or 
muco-purulent exudate containing emigrated leukocytes and desquamated 
and degenerated epithelial cells. When the desquamation is very active, 
the process is suppurative or purulent (nasal catarrh). Erosions and 
hemorrhages are often present. 

What is infective inflammation? How does it differ from 
simple inflammation? 

Inflammation resulting from invasion of the tissues by bacteria, usually 



206 PATHOLOGY 

staphylococci or streptococci. It is more severe than simple inflammation 
and usually ends in suppuration or gangrene. 

What is suppurative inflammation (suppuration)? 

Inflammation characterized by an abundance of leukocytes in the 
exudate and usually of bacterial etiology. Fibrin formation is prevented, 
probably by the bacteria or their products, and the exudate undergoes 
liquefaction necrosis, forming pus. 

What is the pathology of plastic inflammation? 

The exudate contains fibrinogen and the fibrin-ferment is supplied by 
broken-down leukocytes. Fibrin is rapidly formed and causes adhesion 
between adjacent structures (layers of the pleura or pericardium). The 
fibrin later becomes organized and permanent adhesions, with obliteration 
of serous cavities, result. 

What is productive inflammation? 

In productive or chronic inflammation the proliferative changes pre- 
dominate and new connective tissue is formed. Mucous surfaces become 
thickened, granular (granular pharyngitis), or polypoid (gastric and intes- 
tinal mucous membrane). It is also called interstitial when occurring in 
the substance of organs (interstitial nephritis). 

Illustrate and define hypostatic inflammation. 

Inflammation developing as the result of irritants acting on tissue the 
seat of hypostatic congestion. Hypostatic pneumonia occurs as a terminal 
infection in typhoid and other adynamic fevers and always involves the 
dependent portions of the lungs. Particles of food or secretions are aspi- 
rated and act as irritants to the parts already the seat of hypostatic con- 
gestion. 

Describe "termination of inflammation by resolution." 

The emigrated plasma and leukocytes reenter the blood-current or are 
carried off by the lymphatics. The cells, if they are numerous, first undergo 
softening and are absorbed in the form of an emulsion. The prolifer- 
ated connective-tissue cells remain in situ or become wandering cells. 
Phagocytes also take part in the removal of broken-down cells. The 
tissue returns to its normal condition. 

Describe healing by granulation. 

The first stage comprises the usual changes incident to inflammation — 
dilatation of capillaries, exudation of serum, and emigration of leukocytes. 
The injured connective-tissue cells die and are disposed of by absorption 
and phagocytosis. On the second or third day there appear on the wound 
surfaces small red nodules called granulations, containing newly formed 
capillary sprouts, surrounded by proliferated connective-tissue cells — 
round-cells. This granulation tissue in a healthy wound is covered with 
pus — laudable pus. The capillary processes unite with similar processes 
from an adjacent or the same capillary to form new blood-vessels. Their 
newly formed connective-tissue cells or round-cells around the capillaries 
elongate and form new fibrous tissue which afterward contracts and 



SUPPURATIONS 207 

forms the scar or cicatrix. The epithelial continuity is restored by multi- 
plication of the epithelial cells at the edges of the wound and the healing 
process is completed. 

What is the composition of the inflammatory exudates? 

A highly albuminous fluid with a high specific gravity — 1015 to 1030 — 
and alkaline reaction, containing leukocytes, red blood-cells, and a few 
endothelial (mesothelial) cells. 

Explain the development of pus=corpusc!es. 

They are leukocytes, chiefly of the polynuclear type, contained in 
purulent exudates, and, as in inflammation generally, are the leukocytes 
that have passed through the walls of the capillaries. 

Define phlegmon, abscess, ulcer, fistula, furuncle, carbuncle, 
caries. 

Abscess: a circumscribed collection of pus in the substance of a part or 
organ. Phlegmon: diffuse purulent infiltration of a tissue. Ulcer: 
localized suppuration on a free surface with tissue destruction. Fistula: 
a suppurating canal connecting a body cavity or hollow organ with 
another cavity or the free surface of the body. Furuncle: a localized 
suppurative and necrotic inflammation starting in a hair-follicle, sebaceous 
gland, or sweat-gland. Carbuncle: a more extensive but similar process 
with multiple lesions and necrosis or gangrene of the skin and subcutan- 
eous tissue. Caries: molecular destruction of bone (or teeth) correspond- 
ing to ulceration in soft tissues. 

Describe the formation of an acute abscess. 

Pyogenic micro-organisms invade the tissues through a solution of 
continuity in the skin, or an organ by way of the lymph-channels, and in- 
augurate the phenomena of inflammation and suppuration. The col- 
lection of pus is localized and separated from the healthy tissue by a line 
of demarcation called pyogenic membrane. This may be the seat of lique- 
faction necrosis when the suppuration is spreading, or of regeneration 
when the connective-tissue (round) cells are in excess. The abscess 
continues to spread until it reaches the surface, a process termed pointings 
rupture takes place, the pus is evacuated, and the resulting cavity heals 
by granulation. 

Describe the process of ulceration. 

Suppurative inflammation with destruction of tissue, occurring on 
free surfaces — the skin or mucous membranes. The floor of the ulcer is 
covered with granulation tissue and pus, and corresponds to the " pyogenic 
membrane" of an abscess. 

Varieties of ulcer are: phagedenic, spreading ulcers with rapid destruc- 
tion of tissue; serpiginous, extending in one direction while other parts are 
healing; indolent, dry ulcers with scanty granulations and small tendency 
to heal; round or peptic ulcer of the stomach, due to digestion of the wall 
by the gastric juice; pressure ulcers (decubitus) and perforating ulcer of 
the foot, in which the process is neurotic. 



208 PATHOLOGY 

Define gangrene. 

The putrefaction of dead tissues still attached to the living body. 

Briefly describe the types of gangrene, and give the conditions 
determining each. 

Dry gangrene. The tissues are dark, friable, horny, and mummified, 
and separated from the healthy tissue by a line of demarcation. This 
form is due to arterial obstruction and evaporation of the tissue-juices. 
It occurs in old age {senile gangrene) from arteriosclerosis; in Raynaud's 
disease or "symmetric gangrene" a nervous affection characterized by 
spasm of the arteries; in. frost-bite and ergotism, from extreme contraction 
of the blood-vessels. 

Moist gangrene. The affected part is swollen, soft, and pultaceous; 
the fluids are in excess; the color ranges from dark green to black as the 
blood pigment breaks down; the surface is covered with blebs and blisters; 
crepitation can be elicited (gas); the odor is characteristic. In moist 
gangrene the venous circulation is obstructed; it occurs in severe microbic 
infections {hospital gangrene); traumatism and severe inflammations 
destroying the blood-vessels or obstructing the veins; diabetes; nervous 
(trophic) disturbances (certain bed-sores). 

Mention the pathologic changes in gangrenous stomatitis. 

The process begins on the inner side of the cheek with swelling, 
edema, discoloration, and the formation of a nodule, which rapidly under- 
goes necrosis and gangrene. Rarely the sphacelus separates, and re- 
covery ensues, with a disfiguring scar. Pyogenic micro-organisms are 
always present and, in addition, the diphtheria bacillus. Later the 
changes of general sepsis are found. 

What is the line of separation in gangrene? 

The line of ulceration and liquefaction between the line of demarcation 
and the dead tissue. 

Give the causes and pathologic anatomy of lymphadenitis. 

The causes are bacterial, usually the pyogenic cocci, Bacillus tuberculosis, 
or Bacillus pestis. The enlarged lymph-glands are congested, and may 
break down and suppurate; or the condition may end in resolution. 

What inflammatory conditions may result in enlargement 
of the lymphatic glands? 

Infected and suppurating wounds; gonorrheal urethritis, syphilis and 
chancroid, bubonic plague (inguinal glands); diphtheritic, scarlatinal 
inflammation of the throat (cervical glands); erysipelas; tuberculosis; 
actinomycosis. 

What noninflammatory condition may produce enlarge- 
ment of lymph=glands? 

Lymphadenoma and lymphosarcoma; sarcoma and carcinoma; leuke- 
mia and Hodgkin's disease. 



BONKS AND JOINTS 
BONES AND JOINTS 



209 



Give a minute description of and explain the process occur- 
ring in necrosis of bone. 

Necrosis is death of a large or small portion of bone in mass and is due 
to interruption of the blood-supply. This may occur in periostitis, osteitis 
or osteomyelitis, or embolism. The dead fragment, called sequestrum, is 
irregular in outline and more or less eroded, and separated from the 
healthy bone by the process of demarcation, as in necrosis of soft parts — 
absorption of calcareous matter and proliferation of bone-cells. The 
sequestrum, like any foreign body, causes suppuration of the surrounding 
tissues. Fistulas are usually present. A peripheral sequestrum may be 
discharged, and the loss may be made good by proliferation of the perios- 
teal cells. If the sequestrum is central, discharge is impossible, and the 
sequestrum becomes surrounded with hyperplastic material, causing 
thickening of the bone. 

What pathologic changes occur in caries? 

Caseous degeneration and formation of granulation tissue, followed 
by softening and the production of a semifluid, cheesy material containing 
particles of bone. An abscess with a pyogenic membrane covering the 
walls of the cavity may result. The carious focus or abscess may become 
encapsulated by the formation of granulation tissue and cicatrization or 
new formation of bone. 

How is dental caries produced? 

Micro-organisms acting on starchy substances in the mouth produce 
lactic acid, which softens the enamel and permits the entrance of other 
bacteria — saprophytes, bacilli, and micrococci — into the dentin, with the 
production of caries. 

Differentiate between caries and necrosis, giving etiology 
and pathologic anatomy of the latter. 

Necrosis is the death en masse of a large number of cells in the midst of 
living tissue. Caries is the molecular destruction of cells, and corresponds 
to ulceration in soft tissues. 

Causes: Diseases of the periosteum, marrow, and bone, causing inter- 
ruption of the blood-supply; embolism. 

Pathologic anatomy: In necrosis the dead portion of bone or seques- 
trum {sphacelus in the case of soft tissues) is separated from the healthy 
bone by a process of separation. At the line of demarcation absorption of 
calcareous matter and proliferation of cellular elements take place. Fis- 
tulae are usually present. The sequestrum may be discharged or encap- 
sulated. The diseased tissue in caries undergoes gradual softening and 
caseation, with the production of a semifluid material containing par- 
ticles of bone, dentin, or calcareous matter. The process is seen in its 
typical form in tuberculosis of bone. 

What pathologic conditions may be caused by an impacted 
third molar? 

Irritation and hypertrophy of the pericementum; absorption of the 

14 



210 PATHOLOGY 

adjacent roots; neuritis from direct pressure upon the nerve; necrosis of 
the bone from pressure upon the inferior dental vessels. 

Describe the reparative process following the fracture of a 
long bone. 

The successive phases are hemorrhagic extravasation in the marrow 
and at the line of fracture; congestion and cellular infiltration of the 
periosteum, marrow, and bone; formation of new blood-vessels and pro- 
liferation of cells; deposition of calcium and formation of bone and car- 
tilage. The newly formed bone is called callus; the outer portion is 
derived from the periosteum and is called the periosteal or ring callus, 
and the central portion — pin-callus or myelogenous callus — from the 
marrow. After absorption of the excessive callus is completed, some 
thickening persists at the seat of fracture. 

What changes characterize inflammation of bone? 

i. Suppurative inflammation — softening of the bone by absorption 
of the calcium salts and formation of granulation tissue by proliferation 
of the cells in the marrow and in the Haversian canals {rarefying osteitis). 
Localized abscesses or purulent infiltration with necrosis result. 

2. Hypertrophic inflammation — deposition of bony tissue, as in normal 
bone-formation, and increase in density of the bone (condensing osteitis). 

3. Degenerative inflammation — absorption of the calcium salts and 
increased porosity of the bone (inflammatory osteoporosis)) formation of 
cavities containing bone-corpuscles (osteoblasts) and giant-cells — so-called 
Howship's lacunas, increased vascularity and perforation by newly formed 
blood-vessels, establishing communications between neighboring lacunae. 

Mention the characteristic bone changes in rachitis. 

Proliferation of the cellular elements and absence of normal calcifica- 
tion. The head is large and square, and union of the fontanels is de- 
layed. The ends of the ribs at the junction with the costal cartilages are 
enlarged ("rachitic rosary"), as are also the ends of the long bones. 

What is osteomalacia? 

A constitutional disease characterized by absorption of the mineral 
constituents of the bones and increased flexibility, and a variable degree of 
cachexia. It is endemic in certain regions and occurs quite frequently 
during the puerperium. It is regarded by some authorities as a tropho- 
neurosis. 

Describe the changes that occur in cartilage in arthritis 
deformans. 

At first softening and ulceration or erosion, producing a roughness of 
the surface; later the cartilage is gradually absorbed and the ends of the 
bones are exposed. 

TUMORS 

What is understood by the phrase "new formation"? 

The apparently causeless formation of a mass of tissue in some portion 
of the body that does not subserve any useful purpose. 



TUMORS 211 

Give CohnheirrTs theory regarding the cause of tumor for- 
mation, (b) Define sarcoma and carcinoma and give the usual 
method of metastatic extension of each. 

(a) According to the embryonal or evolutional theory (Cohnheim) 
portions of tissue become misplaced during embryonal life and afterward 
take on active growth and develop into tumors. 

(b) Sarcoma, a connective-tissue tumor in which the cells predominate 
so that the intercellular substance is quite insignificant. 

Carcinoma: A historically atypical tumor, composed of epithelial pro- 
liferations and a well-developed connective-tissue stroma. 

Metastasis takes place through the blood-vessels in sarcoma; carci- 
noma extends by — (i) infiltration of the surrounding tissues; (2) by 
metastasis along the lymphatics, and sometimes (3) through the blood- 
vessels (portal circulation). 

(a) On what principle are tumors classified? (b) Mention 
the important classes of tumors, giving an example under each 
class. 

(a) According to the tissue which is the prototype of the cells that 
compose the tumor. 

(b) 1. Parablastomata, or connective- tissue tumors. Examples: 
fibroma (adult type), sarcoma (embryonal type). 

2. Archiblastomata, or tumors after the type of specialized tissue. 
Examples: carcinoma and epithelioma, adenoma, papilloma, endothelioma, 
myoma, neuroma. 

3. Teratomata, or mixed tumors. Example: dermoid cyst. 

Define cachexia. 

A lowered state of the general nutrition due to the absorption of the 
toxic products of disease, usually cancer, tuberculosis, or syphilis. 

The etiology of tumors — (a) What influence has age espe- 
cially as to the connective=tissue type? (b) Sex, if a significant 
factor, denotes a predisposition to what? (c) What is the 
significance of heredity? Of local causes? 

(a) Age. — Connective-tissue tumors are most common in early life, 
when the connective tissues grow most vigorously. 

(b) Sex has little bearing on the etiology of tumors, except in the case of 
cancer, which is more common in females. 

(c) Heredity is considered by some to be an etiologic factor; but the 
more probable view is that the predisposition to tumors and the weakened 
resistance of the tissues are hereditary. 

Local predisposing factors: Irritation is held to be an exciting cause 
(cancer of the lip in smokers; cancer of the cervix developing in an old 
laceration). 

What are the causes of carcinoma of the buccal cavity? 

Irritation, such as that produced by sharp teeth, rough or irregular 
dental plates, pipe stem and cigar. Leukoplakia and chronic inflamma- 
tion. 



212 PATHOLOGY 

Define the term malignant as applied to new formations. 

New formations that recur after removal, give rise to metastasis, and 
ultimately produce death, are called malignant. 

Mention the malignant neoplasms. 

Carcinoma, sarcoma, endothelioma, malignant adenoma. 

What is a sarcomatous tumor? Give its pathology. 

A sarcomatous tumor is one arising from connective tissue, with exces- 
sive cell formation and very little intercellular substance. The cells are 
either embryonic or imperfectly developed connective-tissue cells. Sarco- 
mata are always mesoblastic in origin; their blood-supply is abundant, and 
it is through this channel that they are disseminated; of their lymphatics 
and nerve supply nothing is known. In gross appearance sarcomata are 
of a more or less homogeneous nature, the color depending upon the quan- 
tity of blood present; occasionally a milky fluid can be expressed, but there 
is never anything corresponding to the "cancer- juice" of carcinomata. 
Sarcomata may undergo various secondary changes, such as fatty degener- 
ation, hemorrhages, and mucoid softening. Sarcomata are malignant, 
hence they have a tendency to spread to distant organs (metastasis), are 
heterologous, have no definite limiting capsule, tend to infiltrate the sur- 
rounding tissues, tend to recur after removal, and cause cachexia and 
death. They have been classified in a variety of ways: (i) according to 
the cells, as round-cell sarcoma, spindle-cell sarcoma, giant-cell sarcoma, 
mixed-cell sarcoma; (2) according to the stroma, as fibrosarcoma, myxo- 
sarcoma, chondrosarcoma, osteosarcoma; and (3) according to secondary 
changes, as melanosarcoma, liposarcoma, chloroma. 

Give a brief description of round=cell sarcoma. 

There are three varieties: 

(1) Small round-cell sarcoma, a soft, rapidly growing tumor, resembling 
brain substance. The cut surface is translucent and pinkish-white and 
exudes a milky fluid. It grows larger than any other form. Microscopic- 
ally the tumor is made up almost exclusively of small round-cells with very 
little stroma. 

Differentiate fibrous from sarcomatous epulis. 

Fibrous Sarcomatous 

Pale red, hard, painless. Livid, soft, and painful. 

Size rarely exceeds that of a walnut. Much larger in size. 

Of slow growth. Tendency to rapid growth, ulceration. 

How does sarcoma differ histologically from cancer? 

Sarcoma is made up of embryonal connective-tissue cells with little 
intercellular substance; the blood-vessels are also embryonal and imper- 
fectly formed, without distinct walls. Cancer is composed of epithelial 
cells arranged in plugs or acini, without intercellular substances, and sur- 
rounded by a connective-tissue stroma containing well-developed blood- 
vessels. 



TUMORS 213 

What are endotheliomata? 

Sarcomata originating in the endothelium of lymphatics and blood- 
vessels. 

(a) How is fibrous tissue formed? (b) What tumors are 
composed largely of fibrous tissue, and in what part of the body 
do they usually occur? 

(a) By proliferation of the cells of the preexisting, adjacent fibrous 
tissue and of leukocytes. The nutrition of the young cells, or fibroblasts, 
is maintained by capillaries which spring from the preexisting vessels. 

(b) Fibromata and fibromyomata, or "uterine fibroids," which occur 
chiefly in the uterus. 

Define fibromata. Give the histology of fibromata. 

A benign tumor of slow growth consisting of fibrous tissue. The 
fibrous tissue is poor in cells and consists chiefly of dense intercellular 
substance with few blood-vessels. 

Give the varieties, the histology, and the physical character 
istics of lipomata. 

Sessile, and pedunculated or pendulous. 

The lobules of fat are larger than in normal fat, and the connective- 
tissue trabecular are well developed. 

Rounded, lobulated, encapsulated tumors that can be peeled out 
The consistency varies with the proportion of connective tissue. 

(a) Myoma — definition and histologic description of. (b) 
What determines the benign or malignant nature of a new= 
growth? 

(a) A tumor composed of smooth muscle-fibers — liomyoma, or striated 
muscle — rhabdomyoma. 

(b) Benign Malignant 

Do not disturb the general health. Profoundly affect the general health. 

No tendency to recurrence. Recur after removal. 

No metastasis. Give rise to metastasis. 

Remain within the tissue in which they Break through the limits of the parent 

originate. tissue and , invade the surrounding 

structures. 

Define (a) neuroma, (b) Angioma. 

(a) True neuroma is a tumor composed of nerve-fibers, either medul- 
lated (myelinic neuroma) or non-medullated (amyelinic neuroma). 

False neuroma is a fibrous growth originating in nerve-sheaths. 

(b) A tumor-like formation composed principally of blood-vessels. 

Give the pathology of carcinoma. 

A malignant tumor consisting of plugs or nests (acini) of proliferated 
epithelial cells contained in a stroma of connective tissue. It is not cir- 
cumscribed and has a marked tendency to invade neighboring tissues. 

Describe the pathologic histology of epithelioma and car= 
cinoma. 



214 PATHOLOGY 

The term epithelioma is usually employed to signify squamous carci- 
noma. 

Histology: The epithelial cells are arranged in solid plugs embedded in 
the connective-tissue stroma. Near the periphery the cells are cuboidal, 
at the center flat and arranged in whorls, called pearly bodies. 

Carcinoma (either cylindric or glandular cancer may be meant.) : In 
cylindric cancer or epithelioma columnar cells or goblet cells are found 
near the periphery of the cancer nests; in the glandular form the cells 
are polyhedral. 

Name the tumors of the buccal parieties. 

Angioma, naevus, papilloma and epithelioma. 

Give the gross and the microscopic appearance of an epithe~ 
lioma of the lip. 

An irregular, nodular elevation with ulcerated surface and infiltrated 
base. The microscopic appearance is that of squamous cancer. 

Give the various types of sarcoma and carcinoma, and name 
the sarcomata in the order of their malignancy. 

Carcinoma: (a) squamous; (b) cylindric; (c) glandular. Clinically, 
the following varieties are distinguished: (a) hard or scirrhous; (b) soft, 
encephaloid, or medullary; (c) colloid. Rarer types are: c. myxomatodes, 
giant-cell c, melanocarcinoma. 

Sarcoma: Melanosarcoma, round-cell sarcoma (see p. 212), giant-cell s., 
alveolar s., spindle-cell s., endothelioma, chloroma, psammoma, in the 
order of their malignancy. 

Give the histologic characteristics of adenoma. 

Adenoma originates from preexisting glandular tissue, either from the 
acini or from the tubular portions of the gland. The acini are lined with 
spheroidal epithelium, intercommunicating by ducts. The tubular form 
consists of tubules with cylindric epithelium and originates in mucous 
membranes. 

Give the origin and appearance of papillomata. 

Papillomata originate from the papillae of the skin and from mucous 
membranes. They are wart-like, branching or polypoid, sometimes cauli- 
flower-like masses covered with epithelium. 

Enumerate in order of frequency the tumors of the parotid 
gland. 

Mixed tumors, sometimes called fibro-chondro-myxo-sarcoma, are the 
most common; fibroma, lipoma, chondroma, epithelioma — all of which are 
rare. 

What are cysts? How are cysts formed? Give the varieties 
of cysts. 

The varieties of cysts are: 
I. Non-iumorous: 

(a) Extravasation cysts, resulting from hemorrhage, followed by 
absorption of the blood-pigment and encapsulation. 



TUMORS 215 

(b) Softening cysts, from circulatory disturbance, liquefaction necro- 
sis, and encapsulation. 

(c) Parasitic cysts, as echinococcus or hydatid cysts. 
II. Neoplastic cysts: 

(a) Retention cysts, resulting from obstruction and distention of gland- 
ducts (follicular, mucoid, congenital). 

(b) Dermoid or teratoid cysts. These develop from misplaced em- 
bryonal rests. 

(c) Proliferation cysts or cystadenomata, formed by the proliferation 
of the epithelial cells of gland-acini and secretion of the cells. They are 
usually multiple. 

Describe a retention cyst. 

A cystic tumor resulting from obstruction of a gland-duct, followed 
by distention and accumulation of the secretion. Example: Ranula. The 
epithelium lining the cyst is the same as that of the gland. 

Give pathology of cystic ovary. 

Simple follicular cysts result from distention of the Graafian follicles. 
The cavities are lined with epithelium and the contents are serous or blood- 
tinged. The cyst may be unilocular or multilocular. The organ is con- 
siderably enlarged. 

From what do cysts of the alveolar process arise? 

From the root of a normally erupted tooth, from a non-erupted tooth, 
and from misplaced embryonal tissue. 

What are teratomata? 

Tumors containing elements of different tissues in a situation where 
they do not occur normally. They result from misplacements or inclusions 
of tissue during embryonal life, are mostly cystic (dermoid cysts) , and con- 
tain various epidermal structures, such as hair, teeth, sweat-glands, and the 
like. 

Name the various tumors of the tongue. 

Fibroma, papilloma, lipoma, myxoma, angioma, lymphangioma, 
epithelioma, lymphosarcoma, and lymphadenoma. Ranula is the name 
applied to a cystic tumor on the floor of the mouth, caused by dilatation 
of the duct of the sublingual, or other mucous gland. 

EJECTIONS 

What is the pathology of erysipelas? 

A severe inflammation of the skin and subcutaneous tissues due to 
infection by Streptococcus erysipelatis, accompanied by the formation of 
blebs, and usually ending in resolution, but sometimes in general septice- 
mia and death. 

In uncomplicated cases inflammatory edema and sometimes suppura- 
tion are found postmortem. The cocci are found in the lymph-spaces. 
Infarcts occur in the lungs, spleen, and kidneys; malignant endocarditis, 



2l6 PATHOLOGY 

septic pericarditis and septic pleuritis may develop in erysipelas. The 
meninges are rarely involved. The kidneys show acute nephritis. 

What are the characteristic features of diphtheritic exudation 
or infiltration of mucous membrane? 

The formation of a grayish membrane of varying thickness, firmly 
adherent, and sometimes extending deeply into the tissues; early failure 
of the nuclei to take the stain; the deposition of granular or fibrillar fibrin, 
or in the form of a homogeneous mass, in the cells and intercellular sub- 
stance. The process is a coagulation necrosis. 

What is the special cause of the croupous inflammation 
found in diphtheria? 

The toxin of the diphtheria bacillus. 

What apparent differences in throat lesions in diphtheria 
and follicular tonsillitis? 

The false membrane in diplitheria is grayish in color and covers the 
parts adjacent to the tonsils, as well as the glands themselves. Its removal 
requires some force and is followed by bleeding. In. follicular tonsillitis 
the crypts are filled with a whitish, cheesy material, and the plugs can 
be removed without difficulty and without causing hemorrhage. 

What constitutes the difference between laryngeal or true 
croup and spasmodic croup? 

In the former the larynx is covered with the characteristic diphtheritic 
pseudomembrane; the latter is a purely nervous affection, occurring chiefly 
in rachitic children, without pathologic changes in the larynx, or at most 
a slight catarrhal laryngitis. 

Mention the pathologic changes in gangrenous stomatitis. 

Rapid necrosis of the tissues of the cheek and bony structures of the 
jaw, beginning on the inner side. Rarely a line of demarcation is formed 
and the sphacelus separates, leaving a disfiguring scar. 

What organs are most subject to tuberculosis? 

i. Respiratory tract — lungs, bronchioles, and larynx. 2. Intestinal 
tract — ileum and rectum, mouth and pharynx, rarely the stomach. 3. 
Lymphatic glands. 4. Serous membranes — peritoneum, pleura, men- 
inges, synovia. 5. Bones. 6. Spleen, kidney, and suprarenal bodies. 
7. Brain. 8. Middle ear. 9. Bladder and testicles. 10. Skin. ti. Uterus 
and appendages. 

By what methods would you recognize positively tuberculous 
lesions? 

1. By demonstrating the characteristic cells of tuberculous inflamma- 
tion — epithelioid, lymphoid, and giant-cells. 

2. By demonstrating tubercle bacilli in the lesion. 

3. By animal inoculation. 



INFECTIONS 217 

What pathologic changes are found in Addison's disease? 

Tuberculosis of the suprarenal bodies; pigmentation of the skin. 

Describe (a) the syphilitic lesions of the skin. 

The secondary syphilids are symmetric, polymorphous, run a definite 
course, involve the superficial parts of the skin, and leave little, if any, 
scar. The lesions are erythematous, papular, and pustular. The macu- 
lar syphilid or syphilitic roseola, is circular, of a faint rose-red color, later 
changed to purple and yellowish red, and but little raised above the skin; 
it disappears on pressure. The papular syphilid consists of firm, fleshy 
red elevations from the size of a pin-head to one inch in diameter. Lentic- 
ular and miliary papular syphilids are described, according to the size of 
the lesions, the miliary being very rare. The pustular syphilid may 
develop primarily or from a macular or papular eruption. The lenticular 
(varioliform) and miliary (acneform) are differentiated. The former 
are small, hemispheric, pea-sized pustules with a hard base surrounded 
by an inflammatory areola. The miliary pustules range in size from 
a millet-seed to a pin-head and occur in groups. Both varieties are 
covered with crusts. 

What are the possible lesions in the (a) second and (b) third 
stages of syphilis? 

(a) Macular, papular, or ulcerative syphilids (general cutaneous erup- 
tions) ; mucous patches and condyloma latum (on mucous membranes) ; 
glandular enlargements (buboes); iritis; and falling out of the hair. 

(b) Gummata, ulcers, localized skin lesions (tertiary syphilids, rupia, 
etc.), thickening of the arteries (due to hyperplasia of the intima), and 
sclerotic changes in the liver, kidneys, and central nervous system, especi- 
ally the cord. 

Describe a syphilitic gumma. 

A round tumor, ranging in size from that of a pea to that of a small 
apple, raised above the surrounding surface, and of variable consistency, 
with a tendency to central softening. The center contains grayish or 
yellowish "gummy" material, due to mucoid degeneration. The con- 
nective tissue is abundant and forms a capsule and radiating trabecular 
within the gumma. Microscopically, epithelioid, round cells and giant 
cells are seen, with thickening of the intima of the blood-vessels. 
Gummata on surfaces tend to ulcerate; within organs they usually un- 
dergo absorption. 

What is the most common syphilitic lesion of the tongue? 

The mucous patch. 

Give the lesions in syphilitic affections of the buccal mucous 
membrane. 

During the first stage, the initial syphilitic lesion or chancre. During 
the second stage, inflammation of the mucous membrane and the mucous 
patch. During the third stage, gummata, ulcers and the defects resulting 
therefrom — perforation of the palate, etc. 



2l8 PATHOLOGY 

What are the degenerative changes of arteries? 

Fatty, hyaline, calcareous and amyloid degeneration. 

Describe the pathologic conditions present in atheroma. 

Atheroma is a stage in the process of arteriosclerosis characterized by 
fatty degeneration of the intima and media. The term is loosely em- 
ployed as a synonym of arteriosclerosis. 

To what diseases does calcareous degeneration of the arteries 
predispose? 

Aneurysm; cerebral hemorrhage; infarct (cerebral); dry gangrene. 

How does calcareous degeneration of the arteries influence 
the circulation? 

The resistance due to the heightened blood-pressure increases the work 
of the heart and weakens the muscle; the arteries are brittle and pre- 
disposed to hemorrhage, especially in the brain. 

What conditions may result from enlargement of lymph= 
spaces or lymph=vessels? 

The term lymphangioma is applied to a tumor composed of dilated 
lymph-vessels or lymph-spaces; it may be capillary, cavernous, or cystic. 
Macroglossia is an enlargement of the tongue; macrochilia, of the cheeks; 
congenital cystic hygroma ('hydrocele of the neck'); ncevus lymphaticus of 
the skin; elephantiasis, of the legs and scrotum. 

What structural changes take place in chronic gout? 

Arteriosclerosis, hypertrophy of the left ventricle, and myocarditis; a 
variable degree of cirrhosis of the liver and kidneys (small red kidney). 
Deposition of sodium urate in the articular cartilages (knuckles, ear) is 
the characteristic change; these deposits are called tophi. The joints are 
enlarged and the seat of inflammatory changes (fibrous overgrowth), caus- 
ing deformities. 

What condition of the blood is generally prominent in all 
forms of gout? 

Excess of uric acid in the blood. 

What are the usual pathologic lesions in diabetes mellitus? 

Arteriosclerosis and interstitial nephritis (gouty kidney); cirrhosis of 
the liver, skin eruptions — eczema, furuncles, and carbuncles; gangrene of 
the extremities; pancreatic disease. 

What is cretinism, and with what is it associated? 

A congenital or acquired condition characterized by myxedematous 
swelling, especially of the face, neck, and hands, slowness of speech and 
mental processes or idiocy, and general underdevelopment of the body. 
It is always associated with degenerative disease or absence of the thyroid 
gland. 



INFECTIONS 219 

Describe and illustrate by drawing or otherwise the micro- 
scopic appearance of an adenoid. 

A mass of lymphoid tissue composed of round-cells and held together 
by a small amount of connective tissue. Mucous glands are found in the 
deeper layers. 

Describe the changes in tissue in two forms of nasopharyn- 
geal catarrh. 

Chronic Hypertrophic Nasopharyngitis. — The mucous membrane is 
swollen and reddened, the connective tissue, and sometimes the glandular 
and lymphatic tissue, are increased. 

Atrophic Nasopharyngitis. — There is atrophy of the mucosa, the 
normal constituents being replaced by connective tissue; the ciliated 
epithelium disappears and is replaced by squamous cells. 



BACTERIOLOGY 



Define bacteria; state (a) methods for recognition and culti= 
vation; (b) the conditions most favorable for growth and the 
different ways of entering the body to produce disease. 

(a) Bacteria are unicellular organisms of vegetable nature, devoid of 
chlorophyl, and multiplying by fission. They are recognized by their 
shape, size, motility, grouping, growth, behavior in different culture- 
media, and staining reactions. The chief culture-media are: milk, 
blood-serum, bouillon, gelatin, agar, potato. 

(b) The conditions favorable for their growth are moisture, tempera- 
ture between io° and 40 C, nutritive material in the shape of decompos- 
able organic matter, a medium of neutral or faintly alkaline reaction, and 
rest. Bacteria enter the body through the abraded skin or mucous 
membrane, or through the respiratory and alimentary tracts. 

Give the classification of bacteria and name an example of 
each division. 

Cocci: Streptococcus pyogenes aureus. Bacilli: Bacillus anthracis. 
Spirilla: Spirillum rubrum. Mycobacteria: Actinomyces. 

What are the three basic forms of bacteria? Describe each 
by drawing or otherwise. 

Cocci, bacilli, and spirilla. 

Bacilli: rod-shaped bacteria — Bacillus tuberculosis. Micrococci: per- 
fectly spherical bacteria — Staphylococcus pyogenes aureus. Spirilla: 
spiral, cork-screw forms — Spirochete Obermeieri or spirillum of relapsing 
fever. 

State the difference between parasites and saprophytes. 

Parasites are animal or vegetable organisms that live upon or within 
other living organisms. Saprophytes are vegetable organisms living upon 
dead organic matter; they are non-pathogenic. 

Define the following terms: (a) Coccus, (b) bacillus, (c) 
spirillum, (d) an obligative anaerobe, (e) facultative anaerobe 
(f) Name one anaerobic organism. 

(a) A spherical bacterium, (b) A rod-shaped bacterium, (c) A 
spiral or cork-screw-shaped bacterium, (d) A bacterium that grows only 
in the absence of oxygen, (e) One that grows best without oxygen, but 
will grow in the presence of oxygen, (f) Bacillus tetani. 

(a) Name the pathogenic cocci, (b) Give the morphology; 
(c) method of staining of each, (d) Name the varieties usually 
found in the following diseases: (1) furunculosis, (2) tonsillitis, 
(3) purulent salpingitis. 

220 






CLASSIFICATION OF BACTERIA 221 

(a) Staphylococcus pyogenes aureus, albus, and citreus, Staphylococ- 
cus epidermidis albus, Streptococcus pyogenes, Gonococcus, Diplococcus 
intracellular^ meningitidis, Micrococcus tetragenes, Pneumococcus. 

(b) Staphylococci are in irregular masses or clusters, like bunches of 
grapes; streptococci are in chains; gonococci are shaped like coffee-beans; 
diplococci are in pairs, of which Pneumococcus and Diplococcus men- 
ingitidis are types. 

(c) They are all stained with LoerHer's methylene-blue, as follows: 
Make a film of the bacteria upon a clean cover-slip, dry, and pass three 
times through the flame to fix; pour on the methylene-blue, wash off after 
a quarter of a minute, dry, mount in balsam, and examine with ^ oil-im- 
mersion objective. 

(d) (i) Staphylococcus epidermidis albus. (2) Staphylococcus, strep- 
tococcus, and pneumococcus. (3) Gonococcus. 

Define the following: (a) Bacteria; (b) pathogenic; (c) 
saprophytic; (d) leukocytes; (e) phagocytes; (f) opsonins. 
Describe the theory of phagocytosis. 

(a) Minute unicellular vegetable organisms, composed of an albumin- 
ous substance called mycoprotein or cell-protoplasm, and sometimes sur- 
rounded by a capsule, (b) Capable of producing diesase. (c) Bacteria 
that feed on dead organic matter and usually not pathogenic, (d) The 
white or colorless corpuscles of the blood, (e) Leukocytes (polymor- 
phonuclear) and endothelial cells capable of taking up and devouring inert 
particles (pigments), and dead and living bacteria, (f) Substances con- 
tained in the blood-serum, which act on bacterial cells in such a way that 
the leukocytes are enabled to take them up and digest them by the process 
of phagocytosis. 

Name the important pathogenic anaerobes. 

Bacillus of malignant edema; Bacillus aerogenes capsulatus; Bacillus 
tetani. 

What are pyogenic bacteria? 

Micrococci that produce pus. 

What is a diplococcus? Give the names of two pathogenic 
diplococci. 

Diplococci are cocci or spherical bacteria occurring in pairs. 
1. Diplococcus pneumoniae or Diplococcus lanceolatus or Pneumo- 
coccus. 2. Gonococcus or Micrococcus gonorrhoeae. 

Name the important pathogenic diplococci. 

Micrococcus lanceolatus, Diplococcus pneumoniae or Pneumococcus; 
Diplococcus intracellulars meningitidis (Weichselbaum) ; Micrococcus 
gonorrhoeae or Gonococcus. 

Define the following terms: Germicide, antiseptic, asepsis, 
sterile, disinfectant. 

A germicide is a substance which destroys germ life. An antiseptic 
retards or prevents the growth of septic organisms. Asepsis, absence of 



222 BACTERIOLOGY 

pathogenic or sepsis-producing organisms. Sterile, free from micro-organ- 
isms or spores. Disinfectant, an agent that destroys disease germs and 
the noxious properties of fermentation and putrefaction. 

What are antiseptics? disinfectants? Give examples of each. 

An antiseptic is any substance that inhibits the development of bacteria. 
Examples: bichlorid of mercury, carbolic acid. 

A disinfectant is a substance capable of killing bacteria. Examples: 
formaldehyd, sulfate of copper, bichlorid of mercury in strong solution 
(i to iooo). 

Define pasteurization. How does pasteurization differ from 
disinfection and sterilization? 

Destruction of germs in fluids, such as milk, by heating to 70 or 75 C, 
for 20 minutes. This suffices to kill all ordinary bacteria contained in 
milk, such as typhoid bacilli, colon, diphtheria, and tubercle bacilli and 
the pyogenic organisms, but does not destroy the spores. Pasteurization 
does not impair the palatability or nutritional qualities of the milk. 

In disinfection, bacteria are destroyed by means of chemical agents; 
in sterilization by boiling or exposure to steam, the temperature is raised 
to ioo° C, destroying both germs and spores, and, in the case of milk, this 
brings about a change in chemical composition which renders the milk 
unfit for infant's food except as a makeshift for a very short time. 

Define aerobic, anaerobic. Differentiate facultative aerobic 
and facultative anaerobic. 

Aerobic: The capacity of bacteria to develop in the presence of un com- 
bined oxygen. Anaerobic: The incapacity of bacteria to grow in the 
presence of uncombined oxygen. Facultative aerobic organisms usually 
develop or grow in the presence of uncombined oxygen, but may develop 
under anaerobic conditions. Facultative anaerobic develop normally or 
usually in the absence of oxygen, but may develop in presence of uncom- 
bined oxygen. 

Define and illustrate the terms obligate, pleomorphous, and 
sporogenous. Name and explain the two varieties of chemo- 
taxis. 

Obligate: Having no choice — obligate aerobe. Pleomorphous or pleo- 
morphic — appearing in different forms under different conditions. Sporo- 
genous — spore-forming. 

Chemotaxis is the attracting or repelling force existing between ameboid 
cells, such as leukocytes (phagocytes), and food-particles, or bacteria. If 
the cells are attracted to the food-particles, the term positive chemotaxis is 
used; if they are repelled, negative chemotaxis. 

Define the following bacteriologic terms: Strict parasite, 
spore, flagellum, and mycelium. 

A strict or obligative parasite is a bacterium that feeds exclusively on 
living organic matter. 

Spore: A small, oval, highly refractive body which appears in the pro- 
toplasm of bacteria when the conditions of growth cease to be favorable 






GROWTH OF BACTESIA 223 

and which is capable, in a suitable medium, of developing into a 
bacterium. 

Flagellar Delicate, hair-like projections of the cell-membrane of bac- 
teria which serve as organs of locomotion. 

Mycelium: The growing or vegetative portion of a fungus (mold). 

What is essential to the life of bacteria? 

A suitable temperature, generally at or near that of the body; oxygen is 
generally needed; nutriment of a proper kind, containing both organic and 
inorganic material; a slight degree of moisture; a medium of slightly alka- 
line reaction ; and rest. Some bacteria grow only in the presence of oxygen 
— obligative aerobes; some only in the absence of oxygen — obligative 
anaerobes; most pathogenic bacteria grow as well without as with oxygen 
— facultative anaerobes. 

State why the mouth is a favorable place for the development 
of bacteria. 

Because of the presence of food particles, heat, moisture, and oxygen. 

Give the functions and the products of bacteria. 

Functions: Nutrition (absorption), excretion, growth, motion, and 
reproduction. Products: Fermentation — alcohol, acetic, lactic, and buty- 
ric acid; putrefaction — decomposition of nitrogenous substances with the 
production of ptomains; pigment (chromogenesis) ; gases — C0 2 , H. 2 S., 
N.H. 3 ; odors; disease (pathogenesis); acids; aromatic compounds — indol; 
phosphorescence; reduction of nitrates and formation of ammonia and 
nitrogen. 

Name the different modes by which bacteria propagate, 

(1) By direct or binary division or fission; (2) by sporulation. 

What is a culture? How is it made? State its object? 
Why do you stain bacteria? 

A growth of micro-organisms on a suitable medium in which large 
numbers are massed together. Cultures are made by means of Koch's 
plates, Petri dishes, and Esmarch's tubes. Several tubes containing 
gelatin are inoculated with the material containing the bacteria, forming 
dilutions: the first tube from the infected material, the second from the 
first, and the third from the second. The contents are then poured into 
the Petri dishes, which are placed in the moist chamber to develop. 
Aseptic precautions must be observed. 

The object of making cultures is to isolate the different species of 
bacteria. In the third tube (dilution) the number of bacteria is so small 
that separate colonies, which do not coalesce, will develop where each 
organism falls. 

Bacteria are stained in order to render them more easily visible for the 
purpose of studying them under the microscope, and sometimes for pur- 
poses of differentiation and identification. 

What is a culture medium? 

Any substance, such as bouillon, blood serum, agar-agar, in which 
it is possible to grow bacteria. 



2 24 BACTERIOLOGY 

Name five culture=media. 

Gelatin, agar, potato, bouillon, and blood-serum. 

What is a pure culture? Mention three of the most use= 
ful culture=media. 

A growth consisting exclusively of one species of bacteria. Blood- 
serum; agar-agar; bouillon. 

Discuss symbiosis with special reference to pathogenesis and 
cite example. 

The virulence of bacteria is sometimes increased and sometimes dimin- 
ished by the association in culture of other species of bacteria. For 
example, the toxin of Streptococcus pyogenes is much more virulent when 
obtained from a combined culture of Streptococcus pyogenes and Bacillus 
prodigiosus, while the pathogenicity of Bacillus anthracis is diminished 
by association in culture or symbiosis with Bacillus prodigiosus. 

How do we determine whether a certain organism is or is not 
pathogenic? 

To prove the pathogenicity of a micro-organism: (i) The micro-organ- 
ism must be found in the tissues, blood, or secretions of a person or animal 
sick or dead of the disease. (2) The micro-organism must be isolated and 
cultivated from these same sources; it must also be grown for several 
generations in artificial culture-media. (3) The pure cultures, when thus 
obtained, must, on inoculation into a healthy and susceptible animal, 
produce the disease in question. (4) The same micro-organisms must 
again be found in the tissues, blood, or secretions of the inoculated animal. 

Give Koch's dicta (laws) regarding the bacterial cause of 
disease, and state whether these dicta (laws) are fulfilled in the 
following diseases: Typhoid fever, croupous pneumonia, diph= 
theria, measles. 

See previous question. 

Typhoid fever, no. Pneumonia, yes. Diphtheria, yes. Measles, no. 

To what requirements must bacteria conform to be considered 
the cause of disease? 

See above. 

(a) What is the most effective method of sterilization? (b) 
How would you sterilize culture=media, and why? 

(a) By heat — fire, dry heat or hot air, live (streaming) steam, super- 
heated steam or steam under pressure, and boiling. 

(b) By the intermittent ox fractional method of steam sterilization. The 
culture-medium is exposed to the action of steam in an Arnold or other 
suitable steam sterilizer for fifteen minutes on each of three successive 
days. The first exposure kills all the fully developed bacteria; the bacteria 
which develop from spores in the course of the following twenty-four 
hours are killed by the next sterilization; and after the third exposure the 
medium is absolutely sterile. This method is employed for sterilizing 
culture-media because the prolonged exposure to steam required for the 
destruction of the spores would spoil the medium. 



CULTURE MEDIA 225 

State method of sterilizing the following: fluid culture-media, 
test-tubes, rubber stoppers, rubber gloves. 

Fluid culture-media, see previous question. 

Test-tubes are exposed to 105 C. for one hour in a hot-air sterilizer. 
Rubber stoppers and gloves are sterilized in nascent steam or boiling 
water, rendered slightly alkaline with sodium carbonate. 

Give method of staining cover-glass preparations. 

Spread the material in a thin film on a clean cover-slip, held in a suit- 
able forceps; allow it to dry in the air, and fix by passing three times 
through the flame, Add the stain with a dropper, or place the cover- 
slip in a dish containing the stain for from two to three minutes, wash 
in water or alcohol according to the stain used, dry with filter-paper, and 
mount on a clean slide in water or Canada balsam. 

Synopsis 

1. Spread material on cover-glass. 

2. Dry in air. 

3. Fix by passing three times through flame. 

4. Stain two or three minutes. 

5. Wash in water. 

6. Dry with filter-paper. 

7. Mount in Canada balsam. 

Describe the mode of making cultures on potato. 

The potatoes are scrubbed with a brush, washed with water and 
bichlorid solution, cut into cylinders with a cork-borer, the cylinders cut 
in two on the bias, leaving a long slanting surface, and placed in running 
water overnight. The tubes containing the half cylinders are sterilized 
by heating for three-quarters of an hour each day for three days, after 
which they are ready for use. 

Describe in detail a bacteriologic procedure by which you 
could determine the fecal contamination of a water=supply. 

Fecal contamination is revealed by the presence of typhoid and cholera 
bacilli. The former may be isolated by Pariette's method. To three 
test-tubes containing 10 cc. of bouillon, from 0.1 to 0.3 cc. of the follow- 
ing solution is added: 

Phenol, 5 grains; hydrochloric acid, 4 grains; distilled water, 100 cc. 

From 1 to 3 cc. of the water to be examined is added to each tube and 
the tubes are placed in the incubator. Only typhoid and colon bacilli 
will grow in this medium, and are then plated and separated for the pur- 
pose of counting the colonies. Bacillus coli communis is detected by 
making the fermentation test and counting the colonies. 

How would you proceed to find the number of bacteria per 
cubic centimeter in water? 

Examine the specimen as soon after collection as possible. Plate 
cultures are made on gelatin, agar, or glycerin-agar. According to 
WolfhuegeVs method the Petri dish is placed on a large plate of glass di- 
vided into many small squares. The colonies in a given number of squares 
are counted with a hand-lens, and the number of bacteria per cubic 
*5 



2 26 BACTERIOLOGY 

centimeter estimated. Parke's apparatus consists of a black dish ruled 
with radiating, concentric white lines, printed on white paper. The 
Petri dish is placed over the disk, and the colonies are counted as they lie 
between the radiating and concentric lines. 

Define amboceptors, bacterioproteins, lysins. 

Amboceptors are antibodies having a double combining affinity, one 
linking on to the cell to be destroyed and the other linking on to the 
alexin or complement. 

Bacterioproteins: Proteins produced within the bodies of bacteria. 

Lysins: Substances formed in the blood-serum during bacterial 
infection which are bacteriolytic for the specific germ. They are prob- 
ably identical with agglutinins. 

Define toxins, antitoxins, ptomains, and leukomains. 

Toxins are the poisonous products of pathogenic bacteria. 

Antitoxins are substances formed in the body of a protective character, 
and capable of rendering inert the poisonous products of bacteria. 

Leukomains are basic chemical compounds, closely resembling the 
vegetable alkaloids, produced by the metabolic activities of the organism. 

Ptomains are basic substances resulting from fermentative and putre- 
factive changes in the body set up by the metabolic activities of bacteria. 
Some ptomains are exceedingly poisonous. 

Define immunity. What do you understand by natural, 
acquired, and inherited immunity? 

Natural immunity: The insusceptibility of certain individuals and 
races to certain diseases at all times. The negro is immune against 
yellow fever; mice and rats are immune to diphtheria. 

Acquired immunity is accidental or experimental. Accidental im- 
munity usually results from an attack of an infectious disease, such as 
scarlet fever or small -pox; experimental immunity is always artificial, and 
is produced either by an attack of an infectious disease in a modified form, 
as in vaccination, inoculation with anthrax, cholera, etc., attenuated virus 
or cultures being used; or by the injection of specific antitoxins, sub- 
stances found in the blood-serum of immunized animals which, when 
injected into another animal, confer immunity (diphtheria and tetanus 
antitoxin). The latter is called passive, the former active, immunity. 

Inlterited immunity is natural immunity inherited from one's parents. 

What is infection? 

Infection is an invasion of the tissues by pathogenic bacteria. 

Describe the protective agencies by which the body guards 
itself against the entrance and harmful effects of pathogenic 
bacteria. 

i. Phagocytosis: The devouring and destruction of pathogenic 
bacteria by certain cells (leukocytes and fixed connective-tissue cells) 
called phagocytes. 

2. Phagocytosis depends in part on the presence in the blood-serum of 
certain substances called opsonins, which act upon the bacteria and pre- 






PHAGOCYTOSIS 227 

pare them for consumption by the phagocytes. The nature of these 
opsonins is not known. 

3. The bactericidal power of Ihc blood-serum and other body fluids, 
attributed to the presence of certain proteids called alexins or defensive 
proteids. 

4. The production of substances capable of neutralizing the toxins of 
the bacteria that have invaded the body. These are called antitoxins, and 
their existence has been established in diphtheria and tetanus. 

What are leukocytes, and what occurs when they come in 
contact with pathogenic bacteria? 

Leukocytes are white blood-corpuscles. When they come in contact 
with pathogenic bacteria, if the conditions are favorable, they devour and 
destroy the bacteria (phagocytosis). Sometimes, however, the bacteria 
manage to destroy the leukocytes. 

What is phagocytosis? What is accomplished by it? 

Certain cells in the body, chiefly leukocytes, possess the power of taking 
up and destroying bacteria by intracellular digestion. Metchnikoff, the 
originator of the theory of phagocytosis, at first contended that the destruc- 
tion of bacteria was accomplished solely by phagocytes; but when the bac- 
tericidal and antitoxic power of blood-serum was established by the work 
of Ehrlich and others, he modified his views to the extent that the phago- 
cytes play only a contributory part in the process of immunization and 
destruction of bacteria. 

Discuss hereditary predisposition. 

The physical basis of heredity is believed to be that the chromatin of 
the parent cell, during separation into two or more clusters to form the 
basis of new cells, undergoes an exact longitudinal division, so that the 
new nuclei share in the chromatin substance of the parent nucleus. By 
hereditary predisposition is meant a lack of resistance to certain influences 
(tuberculosis, neuropathic affections) transmitted from either parent to 
the offspring. While it plays a certain role in the etiology of disease, it is 
not so important as was formerly supposed. Constant association with 
a tuberculous subject is of greater significance than a family history of 
tuberculosis. 

In what infectious diseases is immunization of value? 

Small-pox, diphtheria and, possibly, typhoid fever. 

(a) What is antitoxin? (b) What is serum therapy? Name 
two diseases in which it is applied. 

(a) The term antitoxin is applied to a substance or substances in the 
blood-serum that protect against the toxin of a specific disease. 

(b) The invasion of the body by certain pathogenic bacteria gives rise, 
after a time, to substances in the blood-serum which are deleterious to the 
further growth of the invading organism. This principle is made use of in 
serum therapy. Thus, a horse is injected with the toxin of diphtheria 
bacilli, and in a given time his blood-serum will contain substances known 
as antitoxin. The injection of the horse's blood-serum (antitoxin) into a 



2 28 BACTERIOLOGY 

child suffering from diphtheria will give the child the benefit of the pres- 
ence of these antagonistic substances, and thus neutralize the toxin before 
nature can produce them or before the child dies from excessive toxins. 
In the same way serum therapy is applied to tetanus and other infectious 
maladies. In the case of tetanus, antitoxin must be given before the 
toxin has combined with the cells of the central nervous system. 

(a) How is diphtheria antitoxin obtained? (b) Give the 
usual dose. 

(a) A horse is immunized by successive injections of diphtheria toxin of 
such strength that o.i cc. will kill a guinea-pig weighing 500 grams. The 
first injection is 1 cc, and at intervals of eight days larger and larger doses, 
up to 300 cc, are given. The blood is received in sterile bottles- and 
allowed to coagulate in the cold. The serum is removed with a pipet, an 
antiseptic (camphor, phenol, or trikresol) added, and the potency deter- 
mined; 0.01 cc antitoxin should neutralize 0.1 of toxin. A "unit" is the 
amount of antitoxin necessary to protect a 300-gram guinea-pig against 
100 times the fatal dose of toxin. 

(b) The usual curative dose is 5000 units. 

What do you understand by the terms factor and unit as 
applied to antidiphtheritic serum? 

A unit of antitoxin is that quantity of the serum that will neutralize 100 
times the fatal dose of toxin required to kill a guinea-pig weighing 300 
grams. 

Factor is not a term used in connection with antitoxin. 

Give serum test (Widal reaction) for typhoid fever. 

Blood-serum obtained from a typhoid patient, when mixed with a pure 
culture of typhoid bacilli, produces clumping or agglutination of the ba- 
cilli. The G ruber- Widal test is performed as follows: Either fresh or dried 
blood, obtained from a skin puncture, may be used; dry blood-serum is 
first dissolved in sterile water; fresh blood is diluted 5 to 10 times. A 
drop of the serum is placed on a cover-glass, a platinum loopf ul of eighteen 
to twenty-four hours' old bouillon culture of typhoid bacilli added, and 
the two thoroughly mixed. The drop is rimmed with vaselin and the 
cover- slip placed on a concave slide. A high-power (1-8) lens is used for 
the examination. The bacilli first lose their motility and, in about half 
an hour, when the reaction is typical, gather in bunches or clumps. The 
earlier the reaction, the more positive the diagnosis of typhoid fever. 

What is the diagnostic value of Widal's test for typhoid 
fever? 

Its diagnostic value is believed by some to be very great; others place 
little reliance on it. It may be absent in cases of typhoid fever; it may 
be present for several months after an attack; the reaction may not be ob- 
tained until the third week of the disease; it may be present in other dis- 
eases or in perfectly healthy persons. The above have all been urged 
as objections; certainly only positive results have any value. 



THK TUBERCULIN REACTION 229 

In what disease, other than typhoid, do agglutination reac- 
tions occur? 

Paratyphoid fever; epidemic dysentery (Shiga's bacillus); plague; 
cholera; Malta fever; glanders; pneumonia; tuberculosis (doubtful). 

What is tuberculin? How is it produced? What is it used 
for? 

A 50 per cent, glycerin extract of live tubercle bacilli cultures. 

A flask is half filled with veal bouillon containing 4 to 6 per cent, of gly- 
cerin. The surface is inoculated with a pure culture of tubercle bacilli 
and the flask placed in an incubator for from six to eight weeks. The 
bouillon, after evaporation to one-tenth its volume over a water-bath, is 
then filtered, and this filtrate is tuberculin. 

Tuberculin is used as a diagnostic and therapeutic agent. The injec- 
tion of 1 to 5 mg. of tuberculin into a non-tuberculous individual is 
without appreciable effect; but in a tuberculous patient the same dose is 
followed by a decided reaction, characterized by elevation of temperature, 
headache, lassitude, at times nausea, vomiting, and chills. 

Describe in detail the tuberculin reaction. 

See previous question. 

Calmette has devised a simple method of applying the tuberculin test. 
Tuberculin is precipitated with alcohol and the precipitate dissolved in 
sterile salt solution. One drop of this solution (1 per cent.) is instilled 
into the eye and, when the test is positive, an inflammatory reaction and a 
light grayish exudate appear in from six to ten hours. This is called by 
Calmette the ophthalmo-tuberculin test, and by Wolff-Eisner, who claims 
priority, the conjunctival test. Modifications of this test are the percutan- 
eous or cutaneous inoculation test after v. Pirquet, in which the tuberculin 
is rubbed into the skin with a blunt instrument and the inunction test 
devised by Moro. 

The v. Pirquet cutaneous test is the one most generally employed. 

Name some of the principal bacteria of the staphylococci 
and the streptococci groups. 

Staphylococcus aureus, Staphylococcus albus, Staphylococcus citreus, 
Streptococcus pyogenes, Streptococcus erysipelatis. 

What microorganisms are most frequently related etiologi- 
cally to the development of surgical septicemias? 

Staphylococcus pyogenes aureus, albus, and citreus; Streptococcus 
pyogenes; Bacillus coli communis. 

What bacteria are associated with inflammation and sup= 
pu ration? 

The most common are Staphylococcus pyogenes aureus, albus, and 
citreus and Streptococcus pyogenes. Bacillus pyocyaneus (blue pus), 
Pneumococcus, Friedlander's diplococcus, Bacillus coli communis, Bacillus 
typhosus, Gonococcus, Bacillus tuberculosis, and Bacillus epidermidis 
albus are rarer causes of suppuration. 



230 BACTERIOLOGY 

Where is the gonococcus usually found? Describe its charac- 
ters; give specifically a method of staining it. 

The gonococcus attacks cylindric epithelium and is" usually found in 
discharges from the urethra, conjunctiva, and rectum. It does not attack 
flat epithelium, hence gonorrhea of the mouth or nasal passages does not 
occur. A similar organism, Coccus catarrhalis, attacks these, but does 
not attack the urinary bladder — gonorrheal cystitis is really gonorrheal 
prostatitis. Gonococcus attacks the reproductive, not the urinary, organs. 

It is a diplococcus, biscuit shaped, usually found in pairs, and within 
the pus-cells, and cannot be cultivated upon ordinary media. Does not 
stain by Gram. 

No stain is specific, but for a diagnosis it suffices to stain with dilute 
alcoholic solution of methyl ene-blue for one-half minute, mount, and ex- 
amine. If organisms are found, stain by Gram: (a) solution anilm-gen- 
tian violet, two minutes; (b) LugoPs solution, until black, (c) Decolorize 
in alcohol, (d) Wash and counterstain with Bismarck brown, one-half 
minute, (e) Dry and mount. Gonococci are stained brown with Bis- 
marck brown. This suffices for diagnosis usually; for an absolute diag- 
nosis cultures are required. 

Describe a tubercle bacillus. 

A straight, rod-shaped organism, 1.5 to 3.5 /n long and about 0.5 \l 
thick, beaded, often occurring in pairs or groups. It is acid-fast, i.e., 
stains with difficulty (carbol-fuchsin), and retains the stain with great 
tenacity. 

With what bacteria found in milk may the tubercle bacillus 
be confounded? 

The butter bacillus of Rabinovitch. 

State where the smegma bacillus is found, and give the mode 
of differentiating it from the bacillus of tuberculosis. 

Beneath the prepuce of man and between the labia of woman. It is 
differentiated from the tubercle bacillus by the fact that it is decolorized 
by absolute alcohol, and does not produce tuberculosis when inoculated 
into an animal, as it is a non-pathogenic germ. 

(a) Describe in detail the examination of sputum for tubercle 
bacilli, (b) How would you make a bacterial diagnosis of 
diphtheria? 

(a) The small " cheesy" particles in the sputum are selected for exami- 
nation. One of these is picked up with a platinum loop or a tooth-pick 
and thinly spread on a cover-slip or slide. After drying in the air, the 
preparation is fixed by passing it three times through the flame. It is 
then stained for 2 to 3 minutes with carbol-fuchsin over the flame; washed 
in water; decolorized with sulphuric acid, 2 percent, alcohol, 25 per cent, 
water, 73 per cent, for 1/2 minute; and counterstained with methylene blue. 
The tubercle bacillus is stained bright red, everything else blue. 

(b) A diphtheria diagnosis outfit, such as most boards of health supply, 
comprises a culture-tube containing blood-serum, a swab or inoculator in 
a sterile glass tube, and a wooden tongue depressor. The suspected 



PROTOZOA 231 

throat or diphtheritic membrane, if present, is rubbed with the swab and 
the culture-tube inoculated. Swab and tongue depressor are immediately 
burnt. The culture-tube is placed in the incubator or the waistcoat 
pocket, and in from nine to twelve hours small white colonies make their 
appearance, from which smears are prepared. 

Tell in detail how to examine a suspected urethral discharge 
for gonococci. 

Lightly touch the drop of discharge at the meatus with a cover-glass 
and prepare a smear in the usual manner. Stain one with Loeffler's 
methylene-blue and one by Gram's method. The gonococci are recognized 
by their characteristic biscuit shape, position within the pus-cells, and 
failure to stain by Gram's method. 

What are protozoa? Name three pathogenic protozoa. 

A protozoon is an animal organism composed of a single cell. — Plas- 
modium malarias, Entamoeba hystolytica, Trypanosoma gambiense, 
Treponema pallidum. 

What disease does the bite of an infected stegomyia fasciata 
produce (transmit)? 

Yellow fever. 

Name and describe the malarial parasites. 

The malarial parasites are: (1) Plasmodium vivax, the cause of benign 
tertian malaria. (2) Plasmodium malaria, the cause of quartan malaria. 
(3) Plasmodium falciparum, the cause of estivo-autumnal malaria. 

A full-grown malarial parasite is composed of a protoplasm, which is 
circular when at rest, and irregular in outline when the pseudopoda are 
extended. This protoplasm is stained blue by all the ordinary blood- 
stains. Eccentrically placed there is a clear space, which represents the 
nucleus, and at one side of the clear space, when a polychrome methylene- 
blue stain has been employed, there is a red spot which is the chromatin. 
Embedded in the protoplasm of the parasite there are numerous reddish- 
brown granules of malarial pigment, which are in reality altered hemo- 
globin. In a fresh preparation the malarial pigment is seen to be in 
active motion and the pseudopoda can be seen actively extended and 
retracted. 

What is the cause of syphilis ? 

Treponema pallidum, discovered by Schaudinn and Hoffman in 1905, 
a protozoon from 6 to 1 5 micro millimeters in length and presenting from 
6 to 14 spiral turns. It is found constantly in primary and secondary, and 
with difficulty in tertiary lesions. Its presence in a suspected lesion is 
regarded as diagnostic, while its absence does not exclude syphilis. 

Describe a practical method of staining for Treponema 
pallidum. 

A drop of blood-tinged serum is obtained by lightly scraping the lesion, 
smeared on a slide to form a thin film, dried by passing through the 
flame, and fixed by immersion in alcohol and ether for five minutes. 



232 BACTERIOLOGY 

The stain is then applied for fifteen to twenty minutes, the slide washed 
in water, and allowed to dry. Loffler's alkaline methylene-blue may be 
used, but the most successful are Giemsa's and Leishmann's stains. 
Treponema pallidum stains light red with Giemsa's stain, while Spiro- 
chaeta refringens stains blue. 

A convenient and very reliable method of demonstrating Treponema 
pallidum in the living state is by means of the dark ground illuminator or 
condenser, which can be attached to any microscope. 

Describe the Wassermann reaction for the serum diagnosis 
of syphilis. 

A reaction obtained in cases of syphilis between — 

1. A known syphilitic substance (liver extract of syphilitic fetus) or 
lecithin. 

2. The patient's serum. 

3. Normal guinea-pig serum. 

4. The serum of an animal (rabbit) previously injected with 

5. The red blood corpuscles obtained from another animal (sheep). 
The reaction consists in "fixation or deviation of the complement" and 

manifests itself, when positive, by failure of hemolysis to take place. 

The serum of an animal which has been injected with the red blood 
corpuscles of another animal has the property of dissolving ("lysing") 
these corpuscles. The process is called "hemolysis." Heating the serum 
to 56 C. destroys this hemolytic power, which can, however, be restored 
by adding normal, unheated serum, containing complement. (Heat 
destroys complement.) If to complement-containing serum, syphilitic 
serum in which the complement has previously been destroyed by heat 
is added in the presence of a known syphilitic substance or lecithin 
(antigen), hemolysis will not take place. In order to bring about this 
fixation or deviation of the complement, the (syphilitic) patient's serum 
is treated with an extract of syphilitic liver or lecithin, which is known 
as "antigen," so that the antibodies in the serum, with the aid of the anti- 
gen, combine with and fix the complement, thus rendering hemolysis 
impossible. 

In the Wassermann reaction an extract of the liver of a syphilitic 
fetus (antigen), the patient's inactivated serum (antibody), and normal 
serum from a guinea-pig (complement) are added together. This is 
incubated at 37 C. for three-quarters of an hour. At the expiration 
of this time, serum from the rabbit immunized with sheep's red blood 
corpuscles (hemolytic amboceptor) and red blood corpuscles from the sheep 
are added. The whole is then incubated for two hours, after which it 
is placed in a refrigerator over night, for the final determination of the 
reaction in the morning. Failure of hemolysis to take place constitutes 
a positive reaction and indicates the presence of active syphilis. 

The antigen, the patient's serum, and the hemolytic serum must be 
inactivated (to destroy complement) before using by heating them for 
three-quarters of an hour at 56 C. 

As the technic is difficult and exceedingly complicated, the test is 
reliable only when carried out by one having thorough laboratory train- 
ing, and the procedure should not be attempted by any one lacking such 
training. 



THE WASSERMANN REACTION 233 

Positive Reaction. Negative Reaction. 

Antibody + antigen + complement, in- Antigen -f suspected serum containing no 

cubated for three-quarters of an hour antibody (any normal serum) + com- 

(complement is fixed) + hemolytic plement, incubated for three-quarters 

amboceptor + suspension of specific of an hour + suspension of specific red 

red blood corpuscles = no hemolysis. blood corpuscles -f hemolytic ambo- 

The antibody, with the aid of the ceptor = hemolysis. There was no 

antigen, "fixed" the complement and antibody present in the suspected 

so prevented the hemoyltic amboceptor serum to " fix " the complement, so 

from combining with it (the comple- that the hemolytic amboceptor fixed 

ment) and thereby preventing hemoly- it and thereby produced hemolysis, 

sis. This is the positive reaction in This reaction takes place in suspected 

case of syphilis, due to the presence of negative cases on account of the ab- 

the antibody (immune body). sence of the antibody. 

State the significance and value of the Wassermann reaction. 

The reaction has been found positive in the vast majority of syphilitic 
oases in which it has been tested. The figures range from 60 to 100 
per cent, in all forms of syphilis — primary, secondary, tertiary, latent, 
and hereditary. The highest percentages of positive reactions are ob- 
tained in secondary and in hereditary syphilis; the lowest in primary 
and latent. In general paralysis the reaction is positive in about 80 
per cent, of the cases; in tabes, in about 65 per cent. 

The reaction can usually be obtained in the fourth week, that is, 
before the appearance of secondaries; it has also been demonstrated 
during the period of primary incubation, that is, before the appearance 
of the chancre. The effect of treatment on the reaction has not been 
definitely determined. In late syphilis treatment causes the reaction 
to disappear; on the other hand, a previously negative reaction may 
become positive after the administration of antisyphilitic remedies, or a 
feeble reaction may be intensified. This is probably due to a temporary 
flooding of the blood and lymph vascular systems with myriads of dead 
treponemata and their endotoxins. 

Certain other diseases frequently give a positive Wassermann reac- 
tion: scarlet fever, leprosy, yaws (frambesia), and trypanosomiasis. 
Occasionally it is also obtained in cases of tuberculosis and carcinoma. 
These diseases can easily be differentiated by clinical means. 



MATERIA MEDICA AND THERAPEUTICS 



Define materia medica and therapeutics. 

Materia Medica. — That branch of medical science which treats of 
medicinal remedial agents of organic or inorganic origin, their nomen- 
clature, source in nature, physical properties and chemical composition 
methods of preparation, physiologic and toxic effects, and dosage. 

Therapeutics. — The art of applying remedies for the correction of mor- 
bid conditions in the human body or for the relief of symptoms. 

Define tincture, extract, and ointment, and tell, as a rule, 
how many drops of a tincture are in a fluidram. 

Tincture. — A solution in alcohol or aromatic spirits of ammonia of a 
non-volatile substance (exception: tincture of iodin). 

Extract. — A solid or semisolid preparation made by evaporating a 
solution of the active constitutents of vegetable drugs to the required con- 
sistency. 

Ointment. — A fatty preparation, soft or solid at ordinary tempera- 
tures, with a base of petrolatum, lanolin, lard, olive oil, or other unctu- 
ous substance. 

The number of drops to a fluidram varies greatly in different tinctures 
— say from 60 to 1 20. 

What is a fluidextract? 

A solution of a drug in alcohol or dilute alcohol, made by percolation 
and partial evaporation, so that 1 cc. of the solution represents 1 gm. of 
the drug. 

Give the general rule for calculating doses for children. 

Young's Rule: Divide the age by the age plus twelve. The resulting 
fraction will indicate the part of the adult dose to be used. This rule holds 
for all ages over one year. 

What are the modes of administration of medicines? How 
does dosage vary in each with dosage by the mouth? 

By the mouth and stomach; hypodermically; intravenously; by in- 
unction; by inhalation; by rectal injection. Hypodermic and intravenous 
doses should be one-fourth smaller, while the rectal dose should usually be 
one-fourth larger, than the dose given by the mouth. 

No definite rule can be given, as different drugs vary greatly in respect 
to rapidity and completeness of absorption. 

Name and describe the methods of introducing medicines 
into the circulation. 

(1) By the mouth. The drug, either solid or liquid, is swallowed 
and absorbed in the stomach and small intestine. 

234 



MKTIIODS OF ADMINISTRATION 235 

(2) By the rectum in liquid (enema) or semisolid form (suppositories); 
the drug is absorbed by the large intestine. The rectal dose should be 
roughly about double that given by the mouth, or somewhat less in the 
case of narcotics. 

(3) Hypodermic method. The drug in solution in sterile water, salt 
solution, or oil, or protective and curative serums, is injected with a 
hypodermic needle into the subcutaneous areolar tissue, usually of the 
arm, thigh, or abdomen. Perfect asepsis is required. The hypodermic 
dose should be about one-fourth less than the dose by mouth. 

(4) Epidermic or inunction method. The skin is thoroughly cleansed 
with soap and water and then with alcohol, and the ointment {mercurial 
ointment in syphilis) containing the drug, oil, or other unguent {cod-liver 
oil, butter in marasmus) rubbed into the skin. The flexor surfaces of the 
arms and thighs and the front of the chest and abdomen are the sites se- 
lected. 

(5) Inhalation method. Volatile drugs are rapidly absorbed by the 
respiratory mucous membrane {ether, chloroform, etc.). The vapor of 
water may be medicated with the drug and inhaled, usually for local effects. 
Mercury may be administered in a vapor bath for its systemic effect. 

(6) Intravenous method. Used in cases of emergency when rapid ac- 
tion is desired; for the introduction of saline solution; and for certain drugs 
that cannot be injected into the subcutaneous tissue {adrenalin chlorid, 
collar got, arsenobenzol). The needle is introduced into the vein, exposed 
by a preliminary skin incision, or directly by thrusting it through the skin. 

The enepidermic application to the skin without friction, and ender- 
matic application of a drug to a surface denuded of epidermis by vesication 
are now obsolete. 

What is meant by idiosyncrasy? 

An abnormal response to the action of a drug or food. 

On what does the rapidity of effect of medicine depend? 

On the age, sex, temperament, and physical condition of the patient, 
as well as the strength of dose and mode of administration. 

Distinguish prophylactic, palliative, and curative treatment. 

Prophylactic treatment is that used to prevent or abort the formation 
of morbid conditions and to maintain physiologic conditions. 

Palliative treatment is that used to minimize the pain or to limit the 
manifestations of pathologic conditions. 

Curative treatment is that designed to overcome pathologic conditions 
and restore physiologic conditions. 

Describe the method of administering a drug to obtain its 
quickest action. 

Hypodermic injection. The syringe and solution is rendered aseptic, 
the solution placed in the barrel of syringe, the needle pointed upward, 
and air expelled, the needle point inserted in the subcutaneous cellular 
tissue and the contents of syringe injected. 



236 MATERIA MEDICA AND THERAPEUTICS 

What is incompatibility in medicine, and what are the dif- 
ferent kinds of incompatibles? Give an example of each. 

Two or more drugs are incompatible when they cannot be administered 
in the same mixture or at the same time. Drugs may be chemically, 
physically (pharmaceutical^) or therapeutically incompatible. 

(a) Chemical incompatibility occurs when substances precipitate each 
other in solution (unless intentional), form explosive compounds or volatile 
ingredients, or when chemical decomposition takes place. Example: 
Sodium bicarbonate with dilute hydrochloric acid forms carbon dioxid. 

(b) Physical incompatibility: Precipitates are formed without chemical 
action, usually resulting in unsightly mixtures. Example: infusion of 
digitalis with tincture of nux vomica forms a precipitate. 

(c) Therapeutic incompatibility takes place when drugs of antagonistic 
physiologic action are combined. Example: strychnin sulfate and 
aconitin. 

Mention three classes of evils which may result from chemi- 
cal incompatibility in prescriptions. 

Explosions. Formation of poisons. Formation of insoluble or inert 
substances. 

Write a prescription illustrating chemical incompatibility. 

For G. W. Smith. January 1, 1912. 

1$. Potassii iodidi, 3ij; 

Strychninae sulpha tis, gr. ss; 

Ferri sulphatis exsiccati, 5j; 

Syrupi simplicis, foj; 

Aquae, q. s. ad f 5iij. 
M. Sig. — One teaspoonful three times a day after meals. 

Dr. T. L. Jones. 

Potassium iodid is incompatible with the alkaloid and also with the 
metal salt. 

How does an antagonist differ from an antidote? 

Antagonists are drugs which are opposed to each other in their physio- 
logic effects. An antidote is an agent administered for the purpose of 
counteracting the action of a poison, removing it from the body, or pre- 
venting its absorption. 

Antidotes may be (a) Chemical — the nature of the poison is chemically 
changed so that it becomes insoluble or harmless. 

(b) Mechanical — absorption of the poison is prevented by holding it 
in mechanical suspension or by coating the stomach. 

(c) Physiologic — supplies its own peculiar and neutralizing effect upon 
the system. 

Define diaphoresis. Mention three diaphoretics and state 
the dose of each. 

Diaphoresis is the production of perspiration. Pilocarpus, dose of 
pilocarpin hydrochlorid, 1/10 gr. Dover's powder, dose, 2 to 10 gr. 
Sweet spirit of niter, dose, 1/2 to 2 dr. 



DIURETICS AND ANTIPYRETICS 237 

For what purpose is diaphoresis produced? Name three 
diaphoretics. 

Diaphoresis is of value to arrest or mitigate beginning inflammations, 
to promote the absorption of effusions or transudates, to lower body-tem- 
perature, to increase the elimination of toxic material from the blood, and 
to diminish the work of the kidneys. Three valuable diaphoretics are 
pilocarpus, sweet spirit of niter, and Dover's powder. 

For what purpose are diuretics employed? 

Diuretics are employed to increase the quantity of urine excreted (in- 
creased elimination of toxic material), to dilute the urine, to alter its reac- 
tion, and to render it aseptic or antiseptic and non-irritating. 

Describe four diuretics and give the dose of each. 

Potassium acetate is a neutral, white salt of saline taste, readily deliques- 
cent and soluble in water. It is a refrigerant diuretic and renders the urine 
alkaline. Dose: 10 to 60 gr. 

Cqffein is a feebly basic proximate principle, obtained from tea leaves 
or coffee. It is a stimulating diuretic, increasing both the liquids and the 
solids of the urine. Dose: 1 to 5 gr. 

Digitalis, the leaves of digitalis purpurea, obtained from plants of the 
second year growth. It acts as a diuretic chiefly by raising the blood-pres- 
sure in the renal vessels and relieving stasis. It increases chiefly the watery 
elements of the urine. Dose of the tincture, 5 to 15 min. 

Potassium bitartrate is a white, gritty powder which may occur in 
rhombic crystals. It is stated to be the most active diuretic of the po- 
tassium salts. Dose: 1/2 to 4 dr. 

Name the coal=tar products used to reduce temperature. 

Those most commonly employed are acetanilid, antipyrin, and acet- 
phenetidin (phenacetin) . 

By what methods do antipyretics act? Give an example of 
one that acts by each method. 

Antipyretics reduce the temperature by diminishing heat production, 
increasing heat elimination, or both. Acetanilid and antipyrin act by 
diminishing the production of heat and increasing heat dissipation. Heat 
production is the function most affected. Aconite acts through increased 
heat radiation, resulting from vascular relaxation and impaired circulation. 
The cold bath acts by abstracting heat. 

What are antipyretics? Describe their general uses and 
state how they are administered. 

Antipyretics are agents employed to reduce body temperature. The 
coal-tar derivatives, such as acetanilid and antipyrin, are administered by 
the mouth in doses varying from 2 to 10 gr. They are occasionally useful 
in sthenic fevers, but should not be employed in asthenic or adynamic 
fevers. They have been largely supplanted by cold water. Cold water 
not ony reduces the temperature, but stimulates the general circulation 
through the vasomotor and nervous systems, as well as the processes of 



238 MATERIA MEDICA AND THERAPEUTICS 

oxidation and nutrition, and aids in the elimination of effete material. 
It is employed in the form of sponging, the plunge bath, etc. 

Define a mydriatic. Give three examples, with the dose for 
the local application in each case. 

Mydriatics are drugs which produce dilatation of the pupil. 

A tropin sulfate: dose, one or two drops by instillation of a solution con- 
taining 4 gr. to the fluidounce. Homatropin hydrochlorate: solution of 8 
gr. to the fluidounce, one drop is instilled every ten minutes for an hour. 
Duboisin sulfate: 2 gr. to the fluidounce, one to two drops. 

Name the therapeutic uses of carbolic acid except as an 
antiseptic. 

Externally, carbolic acid or phenol in concentrated form is a caustic 
and local anesthetic. It is used chiefly in skin diseases to relieve itching, 
and may be employed in minor operations, such as eversion of ingrowing 
nails and opening a boil or felon. It is sometimes injected into enlarged 
glands to prevent suppuration, and to abort boils and felons. Locally, it is 
employed in diphtheria, stomatitis, and tonsillitis. As a spray it is useful 
in gangrene and tuberculosis of the lungs. Internally, it is serviceable in 
gastric irritation, vomiting, and diarrhea due to fermentation. 

Mention one drug that contracts the pupil of the eye; one 
drug that dilates the pupil of the eye. 

Eserin causes contraction of the pupil and belladonna dilates. 

Name the principal remedies used for convulsions occurring 
in dentition. 

The use of drugs is to be avoided if possible, although small doses 
of sodium bromid may be given. The patient should be placed in a 
hot bath and cold applications made simultaneously to the head. When 
convulsions are arrested, free lancing of the gums over the erupting tooth 
or teeth is indicated. 

Give the treatment of hemorrhage after extraction. 

Apply styptics such as alum, tannic acid, adrenalin chlorid, or 
chlorid of zinc. Adrenalin may be administered internally. In severe 
cases the socket should be packed with gauze or plaster of Paris and 
a compress placed over the packing, bandaging the jaws, in occlusion, 
with a Barton bandage. 



'■r v 



What precautions should be observed in both the anestheti= 
zation and devitalization methods of removing pulps and subse= 
quent treatment. 

Aseptic conditions should be maintained in both methods. In devi- 
talization method care should be taken to perfectly seal in the drug and 
not to leave it in too long. An antiseptic dressing should be sealed in 
as a subsequent treatment of the canal. 

If aseptic conditions have been maintained and the pulp entirely re- 
moved by the anesthetization method, the hemorrhage should be checked, 
the canal cleaned and permanently filled at once. 



ARSENIC 239 

What preparation of arsenic is most used in dentistry, and 
what is the local action of this preparation? 

Arsenious oxid. (Arsenious acid). 

The action of the drug is irritating to the pulp, causing hyperemia, 
congestion, strangulation, and death of the organ. This action may 
or may not be accompanied by pain. 

Describe the physiologic action of arsenic and name three 
indications for its use. 

Externally, it acts as a powerful escharotic if the skin is broken or a 
wound or sore exists. Upon the nervous system in medicinal amounts 
it acts as an excitant and as a stimulant to the trophic nervous apparatus. 
In moderate dose it has no effect upon the circulation, large doses cause 
a decrease in the force and frequency of the pulse with a fall in arterial 
pressure. The respiratory center is stimulated by small amounts. In 
toxic quantity it is a powerful respiratory depressant. In medicinal 
amount it decreases tissue changes. 

It is indicated in anemia, chorea, and malaria. 

In dentistry it is used to devitalize pulps. 



What is arsenious acid? Give medical properties and 
special dental use and antidote. 

Arsenic trioxid acts as an alterative tonic, stimulates appetite and 
digestive secretions, stimulates respiration and circulation. 

In dentistry it is used to devitalize pulp. Antidote, Freshly prepared 
hydrated sesqui-oxid of iron, or locally, dyalized iron. 

State the reasons for or against the use of arsenious acid to 
obtund sensitive dentin. 

Arsenious acid in the most minute quantity will cause death of the 
pulp eventually. 

Name the drugs that may be combined with arsenic for 
devitalizing a tooth pulp, and state what purposes these drugs 
serve. 

Morphine sulfate or acetate, cocain hydrate and carbolic acid as 
sedatives and anodynes (local), also any essential oil as a sedative and 
vehicle. The sedative drugs counteract the pain caused by the 
irritation of the arsenic. 

How should any injurious results arising from the local 
action of arsenic on the gums be treated? 

Curetment of necrosed tissue followed by bathing the part with 
dyalized iron and tincture of iodin. 

Describe the properties, dental use and application of copper 
sulfate. 

Copper sulfate is a blue, crystalline, odorless substance, possessing 
a bitter, metallic taste. Soluble in water. In dilute portions it is astrin- 
gent; in strong solution, caustic. Internally it is used as an emetic in 



240 MATERIA MEDICA AND THERAPEUTICS 

5 to 10 gr. doses. In dentistry it is used as an astringent and in certain 
kinds of electric cells. 

Describe sodium peroxid and its dental uses. 

Sodium peroxid or dioxid is a white crystalline powder, of a salty, 
metallic taste. It liberates nascent oxygen in contact with tissue. It 
combines chemically with hot or even warm water, with explosive vio- 
lence. It is used as a bleaching agent for discolored teeth. 

What is hydrogen dioxid? Give its formula and dental use. 

Hydrogen dioxid, H 2 2 , is a rather unstable combination of hydrogen 
which gives off nascent oxygen in contact with organic matter, especially 
pus. The official preparation is an aqueous solution, slightly acid, con- 
taining, when freshly prepared, about 3 per cent, by weight of pure 
dioxid, corresponding to about 10 per cent, of available oxygen. In 
dentistry it is used wherever there is pus to be destroyed, and as an anti- 
septic. It is especially valuable to disinfect and mechanically cleanse 
root canals, and abscess fistulas, and to soften salivary deposits. In 
condensed form it is used for bleaching. 

For what is hydrogen peroxid used? 

It is used to destroy pus, to purify and mechanically cleanse putres- 
cent pulp canals, as a germicide, disinfectant, and as a bleaching agent 
and tartar solvent. 

What is pyrozone? How does it act and for what is it used? 

Pyrozone is a form of hydrogen peroxid. An aqueous, 3 per cent, 
solution, is used as a mouth wash, and is antiseptic, owing to the 
liberation of nascent oxygen in contact with organic substances. The 
ethereal, 25 per cent, solution, is caustic and styptic. A 5 per cent, ethereal 
solution and the 25 per cent, ethereal solution are used for bleaching. 

Mention two agents used in bleaching teeth and describe the 
method of their application. 

Calcium hypochlorite and sodium dioxid. 

Calcium hypochlorite is packed into cavity of tooth and moistened 
with a 10 per cent, solution of acetic acid. The chlorin evolved com- 
bines with elements of the stain, changing its composition and decolor- 
izing it. 

Sodium dioxid is packed in cavity and moistened with water. Nascent 
oxygen is evolved, which attacks the stain, oxydizing it and decolorizing 
it. 

What remedies are useful for relief of toothache caused by 
the near approach of caries to the pulp? 

The essential oils, cocain hydrochlorate, sodium bicarbonate, car- 
bolic acid and Robinson's remedy. 

Mention (a) three remedies for toothache caused by expo= 
sure of the pulp ; (b) two remedies for pericementitis. 

(a) Chloroform, oil of cloves, carbolic acid, (b) Tincture of aconite 
and tincture of iodin. 



ANALGESICS 24 1 

Name three drugs or preparations useful in treating or pro- 
tecting recently exposed pulps before filling the cavities. 

Crystals of thymol, oxid of zinc and oil of cloves are used to protect 
the pulp, covered with a metal cap, prior to tilling. 

Give abortive treatment for impending alveolar abscess. 
Give rationale of such treatment. 

The canal should be opened to permit escape of gases. Cold appli- 
cations should be made to the tissues over the end of the root. After 
thorough cleansing of the canal, a dressing consisting of equal parts of 
thymol and carbolic acid (thymol crystals dissolved in the phenol) or a 
5 per cent, solution of formalin should be sealed in for a few days. 

This treatment removes the cause and stops the formation of inflam- 
matory exudates. 

Name the remedies applicable to the treatment of dental 
erosion. 

To neutralize the acid condition, milk of magnesia as a mouth wash 
at night is indicated. Internally doses of lime water, sodium carbonate 
and magnesium sulfate tend to produce alkalinity of the saliva. 

Name four agents used in acute diseases of the pulp and give 
the physiological action of each. 

Morphin (anodyne) has the effect of inhibiting the action of the sen- 
sory nerve centers. 

Menthol and chloroform have an anesthetic and sedative effect. 
Cocain acts as an anesthetic and analgesic. 
Carbolic acid has an antiseptic and sedative effect. 

What is an analgesic? Mention three. 

An analgesic is an agent which overcomes pain, such as cocain, mor- 
phin, oil of cloves. 

What are topical remedies? (b) Mention two classes, (c) 
Give two examples of each. 

Topical remedies are those which are applied locally on the surface, 
(b) Ointments, plasters, (c) Mercuric ointment, ichthyol ointment and 
belladonna plaster, mustard plaster. 

What is meant by the active principles of a drug? Give 
example. 

The active principle of a drug is the substance or part which gives 
the drug its medicinal properties. Strychnin is the active principle of 
nux vomica. 

Mention three alteratives. 

Arsenic, mercury, iodin. 

What is meant by cataphoric application of a remedy? 

The application of an electric current to a part to assist the penetra- 
tion of a drug. 
16 



242 MATERIA MEDICA AND THERAPEUTICS 

Mention two purposes for which medicine may be applied 
cataphorically in dentistry. 

For the desensitizing of dentin and to aid absorption of a bleaching 
agent. 

What is the advantage of the cataphoric as compared with 
the ordinary local application? 

The more rapid and deeper penetration of the drug. 

What two drugs are particularly useful in cataphoric applica= 
tions? 

Cocain hydrochlorate to anesthetize the dentin or pulp tissues, and 
pyrozone, 25 per cent., for its bleaching action. 

What are the dental uses for the alkalies? Mention three 
alkalies. 

To counteract the effect of acid saliva, and after the administration 
of acid medicines. Sodium bicarbonate, magnesium, and lime. 

State the dental uses of nitrate of silver. 

It is used as a caustic for ulcerative conditions of the mucous mem- 
brane, for hypersensitive dentin, for gangrenous stomatitis, and to 
sterilize decay in cavities in deciduous teeth. 

State the conditions under which it is more advantageous 
to give medicines hypodermically than to administer them inter- 
nally. 

To obtain a rapid action of the medicine, when the condition of the 
stomach precludes the administration internally or when patient is un- 
conscious and cannot swallow. 

What is iodoform? Give a solvent and state dental uses. 

Iodoform is a yellow crystalline substance containing about 96 per cent, 
iodin, obtained by adding iodin to alcohol and potassium carbonate. It 
is soluble in alcohol, ether, and chloroform. In dentistry it is used as an 
antiseptic root canal dressing, and in the form of gauze as packing for 
surgical wounds. 

What is the objection to the use of iodoform? Mention three 
drugs that may be used in place of iodoform. 

The disagreeable odor. Acetanilid, aristol, or iodol may be used in 
its place. 

Of what is each of the following an alkaloid: (a) strychnin, 
(b) atropin, (c) morphin. State the dose of each. 

(a) Strychnin, alkaloid of nux vomica, 1/60 to 1/20 gr. 

(b) Atropin, alkaloid of belladonna, 1/ 150 to 1/100 gr. 

(c) Morphin, alkaloid of opium, 1/8 to 3/8 gr. 

What property of tincture of iodin makes it of value in 
pericementitis? 

Its counterirritating property and its stimulating effect on the lymph- 
atics, causing them to absorb inflammatory products. 






ESSENTIAL OILS 243 

Give the indications for the use in producing sleep of (a) 
morphin, (b) chloral, (c) potassium bromid. 

(a) Morphin is used to allay pain and thereby induce sleep. 

(b) Chloral is valuable when insomnia is due to nervousness and not to 
pain. It should not be used when the heart action is weak. 

(c) Potassium bromid is used to allay nervous symptoms and thereby 
induce sleep. It is valuable in epilepsy, hysteria, convulsions, seminal 
emissions, nervous insomnia, etc. 

Differentiate fixed oils and volatile oils and give three exam= 
pies of each. 

Fixed or fatty oils are permanent nonvolatile substances, which leave 
a greasy, spreading stain on paper. They are formed principally of olein, 
stearin, palmitin. Examples: Castor, linseed, and olive oils. 

Volatile or essential oils are volatile in air at ordinary temperatures, 
do not leave a greasy stain on paper, and are formed principally of stear- 
optin (solid) and eleopten (liquid). They form as a rule the aromatic 
principle of the plant from which they are extracted. Examples: Oil of 
cloves, gaultheria, peppermint. 

What are the dental uses of the essential oils? 

As sedatives in inflammation of the pulp; as antiseptics in root canal 
dressing, mixed with arsenic to counteract the irritating effect of arsenic; 
and as antiseptics in mouth washes and tooth powders. 

Give the dental uses of oil of cinnamon, silver nitrate, 
aconite, capsicum. 

Oil of cinnamon is used as a local anesthetic or sedative in odontalgia 
from an exposed pulp, as an antiseptic in root canal treatment, and as a 
flavor in washes and dentifrices. Silver nitrate is used as a caustic in 
ulcerative conditions of the mucous membrane, for the treatment of sen- 
sitive dentin, and to sterilize cavities in deciduous teeth. 

Aconite (See page 244). 

Capsicum is used as a counterirritant applied to the gum in perice- 
mentitis and in some mouth washes for its stimulating effect. 

From what is pepsin obtained? (b) State medical properties 
and dose. 

Pepsin is prepared by macerating the mucous membranes of hog's 
stomachs in water acidulated with hydrochloric acid, clarifying by standing, 
and decanting. Sodium chlorid is then thoroughly mixed with it. The 
pepsin floats to the surface and is removed and purified by redissolving in 
acidulated water and reprecipitating. 

In an acid medium, pepsin acts upon proteids, converting them first 
into albumoses, then into peptones. It is a powerful aid to the natural 
gastric digestive ferment. Average dose: 4 gr. (250 milligrams). 

Give the medical property and dose ; when indicated in dental 
practice and how used ; toxic effects, if any ; antidotal treatment 
of each of the following: Aconite, quinin, naphthol, creosote, 
oil of cloves. 



244 MATERIA MEDICA AND THERAPEUTICS 

Aconite internally acts as a respiratory and circulatory depressant, in 
large doses paralyzing the heart action. In dentistry it is applied to 
gum tissue as a sedative in pericementitis. Dose, i to 3 min. of the tinc- 
ture. Antidotes: strychnin, whiskey, digitalis, and artificial respiration. 

Quinin internally acts as a cerebral stimulant and finally congestant, 
if given in excessive dose. It is an antiperiodic, antipyretic, and antisep- 
tic. It increases the number of red cells in the blood and prevents 
diapedesis of the white cells. Stimulant and tonic to the stomach. Small 
doses act as a stimulant to the entire body; large doses as a vascular 
sedative. Small doses act as a respiratory stimulant; large doses as a 
marked depressant. Dose tonic 1 to 4 gr.; antiperiodic, 4 to 20 grs. 
Morphin is the antidote for cerebral effects and atropin for its anti- 
periodic and antipyretic effects. In dentistry quinin is used in septic 
fevers and locally as an antiseptic and tissue stimulant in treating 
pyorrhea. 

Napthol is an antiseptic. It is used in dentistry in the form of hy- 
dronapthol as an antiseptic wash. 

Creosote internally acts as an expectorant. Dose, 2 to 5 min. Small 
doses have little effect on the nervous system, circulation or respiration; 
but large doses cause depression, stupor, convulsions, respiration stimu- 
lated, renal irritation, and suppression of urine. Antidote, mucilaginous 
drinks followed by stomach pump, digitalis. In dentistry it was used in 
the same manner as carbolic acid, but is now seldom used owing to its 
disagreeable odor. 

Oil of cloves is one of the aromatic essential oils. It is an antiseptic, 
stimulant, counterirritant and mild local anesthetic. Dose, 1 to 3 min. 
In dentistry, it is used to allay odontalgia, as an antiseptic root dressing, 
and as an antiseptic and flavoring agent in mouth washes, dentifrices, etc. 

Mention two drugs insoluble in water. 

Mercurous chlorid and bismuth subnitrate. 

Mention three essential oils and state their dental uses. 

Oil of cloves, in the treatment of odontalgia from inflamed pulp. 
Oil of cinnamon, as an antiseptic root canal dressing. 
Oil of wintergreen, as an antiseptic and flavoring agent in mouth washes, 
dentifrices, etc. 

What remedies, general or local, aside from operative pro- 
cedure, are useful for the relief of toothache? (a) When the 
pulp is alive and not exposed? (b) When pericementitis has 
supervened on death of the pulp. 

(a) Oil of cloves or cinnamon, sodium bicarbonate, chloroform and 
menthol, and carbolic acid. 

(b) Iodin and aconite painted on gum over apex of root. Capsicum 
used in the form of plaster or in rubber suction cup applied to the gum. 

Mention a (a) coagulating antiseptic, (b) noncoagulating 
antiseptic. 

(a) Carbolic acid, (b) Oil of cinnamon. 



MINERAL ACIDS 245 

What is meant by the physiologic action of a drug? 

The changed or altered functions and symptoms produced by the drug 
on the system or part. 

Define astringents. Mention two vegetable and two mineral 
astringents. 

Astringents are agents which cause contraction of the blood-vessels 
and capillaries and lessen the secretion of mucous tissues. They coagu- 
late albumin. They are used as tonics to the mucous surfaces. 

Vegetable astringents: catechu, geranium. 

Mineral astringents: sulfuric acid, lead acetate. 

Mention three alteratives and state the dose of each. 

Mercuric bichlorid, 1/32 gr. 
Potassium iodid, 5 to 60 grs. 
Stillingia (fluid extract) 1/4 to 1 fluid dr. 

Mention three drugs useful in the treatment of pyorrhea 
alveolaris and state their effects. 

Hydrogen dioxid; oxidizes the pus and by ebullition mechanically 
cleanses pockets. 

Sulfuric acid or ammonium bifluorid; dissolves the remnants of 
tartar left by the scalers and stimulates granulation of tissues. 

Quinin; acts as an antiseptic and tissue stimulant after the pockets 
have been cleansed. 

Note. — Emetin hydrochlorid has superseded the use of all other drugs 
in the treatment of pyorrhea in modern dental practice (see page 305). 
Emetin is an alkaloid obtained from ipecac, and is believed to have a 
specific action on Entamoeba gingivalis, which is found in the oral secre- 
tions in most cases of pyorrhoea alveolaris. 

What is trichloracetic acid? What are its properties and 
dental uses? 

Trichloracetic acid is a colorless, odorless, crystalline substance ob- 
tained by the action of nitric acid on chloral. It is soluble in water, 
alcohol, ether, chloroform, etc. 

It is a powerful caustic and is valuable in dentistry to digest fungoid 
pulps, cauterize ulcers and as a tartar solvent. 

Mention the mineral acids employed in dentistry and give 
the properties and uses of each. 

Hydrochloric acid is used in full strength as a caustic and escharotic. 
Diluted, as a tonic, refrigerant and astringent. Combined with glycerin, 
it is used in ulcerative conditions of the mucous membrane, sloughing and 
aphthous ulcerations in children's mouths. 

Sulfuric acid. In full strength it is an escharotic and caustic. Diluted, 
it acts as a tonic, astringent and refrigerant. 

Concentrated sulfuric acid is used as a caustic for ulcerative con- 
ditions of the mucous membrane and in the form of a paste with zinc 
sulfate for gangrene and cancrum oris. 50 per cent, sulfuric acid is 
used as dentin solvent in minute root canals, a tartar solvent and tissue 
stimulant in pyorrhea, followed immediately by sodium bicarbonate. 
The hot acid is used to cleanse the oxid from gold work. Dilute or 



246 MATERIA MEDICA AND THERAPEUTICS 

aromatic sulfuric acid is used in the treatment of ulcerative conditions, 
necrosis and alveolar abscess. 

Nitric acid in the pure state is a powerful caustic and escharotic. 
Diluted, it acts as a tonic, refrigerant and alterative. It is used as a 
caustic in ulcerative conditions of the mucous membrane, to desensitize 
hypersensitive dentin and to sterilize cavities in deciduous teeth. Nitric 
and hydrochloric acids combined (aqua regia) acts as a solvent of gold. 

Define chromic acid. State the dental use of chromic acid. 

Chromic acid or chromium trioxid is a powerful caustic and escharotic 
and will dissolve almost any kind of tissue. It is also a powerful oxidizer. 
It is employed for the removal of warts, corns, condylomata, and similar 
conditions, and in rhinologic and laryngologic practice. In dentistry 
it is used as a caustic for ulcers to digest abnormal tissue growths and in 
weak solutions as a tissue stimulant. 

Give a remedy for pains after tooth extraction. 

Saturate a pledget of cotton with campho-phenique in which a small 
amount of cocain hydrochlorid has been dissolved; and pack the socket. 

State the physiologic effect of both heat and cold on the tissues 
and state the conditions in which each is indicated. 

Heat produces expansion of the blood-vessels, diapedesis of the white 
blood corpuscles and absorption of inflammatory exudates. It is indi- 
cated to hasten the formation of alveolar abscess and to direct the flow of 
pus and in all cases where the stimulation of the blood-vessels is indicated. 

Cold causes contraction of the blood-vessels, stops absorption of exu- 
dates, overcomes inflammatory conditions and, when continued, produces 
anesthetization of the nerve endings. It is indicated to abort the forma- 
tion of an abscess, to prevent the flow of pus to the external surfaces and 
in all cases where the reduction of inflammatory conditions is desired. 
Intense cold is valuable as a local anesthetic in extraction of teeth and 
minor operations. 

State the therapeutic advantages that may be gained by the 
use of compressed air. 

Steady streams of hot air favor absorption of medicaments in the den- 
tin and even without medication overcome hypersensitive dentin through 
dessication. Thorough dessication of root canals by means of hot air 
favors the subsequent penetration of antiseptics. Pus pockets and inter- 
spaces between teeth may be thoroughly cleaned with a well directed 
stream of compressed air. Antiseptics may be sprayed in throat, nose and 
mouth by means of spray bottles connected with the compressed air tube. 

What is a counter=irritant? Name two used in the mouth. 

A counter-irritant is an agent used to produce an inflammation at a 
point, increasing the flow of blood to that point and diminishing the amount 
of and flow of blood at an underlying point, thereby reducing pressure and 
consequent pain. Capsicum, tincture of iodin. 

For what conditions in the mouth is sulfuric acid useful? 
In what strength and in what manner may it be employed? 

Sulfuric acid, 50 per cent., is used in the treatment of hypersensitive 



IRON PREPARATIONS 247 

dentin, pyorrhea alveolaris to dissolve fragments of calculus and to en- 
large minute canals in roots. In the last two named cases it is applied 
with a noncorrosive probe and neutralized with sodium bicarbonate. In 
25 per cent, solution it is used in the treatment of necrosed bone followed 
by an antacid wash. 

What conditions about the mouth call for the use of iodin 
and what are its effects? 

In pericementitis and epulis it acts as an astringent and counter- 
irritant. In green stain for its solvent and bleaching effect. As an 
antiseptic with carbolic acid in the treatment of fistulas. As an astringent 
and anodyne (local) following the setting of artificial crowns, etc. 

What is the danger of using acids in the mouth? What 
precaution should be taken? 

They are apt to cause decalcification of the teeth. Acid medicines 
should be administered through a glass tube and an antacid wash should 
always follow their use. 

Describe three preparations of iron and state the therapeutic 
use of each. 

Tincture chlorid of iron. A reddish, clear liquid, used as a tonic. It 
increases the number of red cells in the blood. Indicated in anemic 
conditions. 

Oxid of iron, in the form of the freshly prepared hydrated sesqui- 
oxide of iron. A brown mass of wet powder used as an antidote for 
arsenic. 

Solution of sulfate of iron (Monsel's Solution). Composed of 7 
parts sulfate of iron, 7 parts of nitric and sulfuric acid and distilled 
water. It is used in the treatment of hemorrhage after extraction, but it is 
liable to cause secondary hemorrhage owing to the fact that its clot is 
soluble in the oral fluids. 

Name two escharotics, and state when escharotics should be 
used. 

Nitrate of silver, carbolic, or trichloracetic acid. 

In ulcerative conditions of the mucosa, and in hypertrophied gum or 
pulp tissue, to obtund hypersensitive dentin; to disinfect; and, to stimulate 
granulations in fistulous tracts. 

Name four properties that a dentifrice should possess. 

Antiseptic power, alkaline reaction, agreeable taste and solubility in 
saliva. 

Name the ingredients of a desirable dentifrice and specify the 
properties that make each of these ingredients desirable. 

Prepared chalk gives bulk, alkalinity and abrasiveness. 
Orris root gives pleasant flavor. 
Cuttle fish bone for its abrasive properties. 
Pulverized sugar to sweeten and overcome the chalky taste. 
Pulverized soap to remove fats and oils from the enamel surfaces and 
to produce a foam. 



248 MATERIA MEDICA AND THERAPEUTICS 

Sodium bicarbonate for its antiseptic and antacid qualities. 
Menthol is antiseptic, cooling, and stimulating to the tissues. 

What is an antiphlogistic? 

An agent employed to reduce the heat of inflammation. 

What is an escharotic? 

An agent which causes decomposition when brought in contact with 
organic tissues. 

Define expectorant. 

An expectorant is a drug which increases or modifies the secretions 
of the respiratory tract, particularly the bronchi. 

Differentiate a tonic and a stimulant. 

Tonics give tone to the system, and stimulate secretion and metabo- 
lism. Stimulants increase the activity of an organ or part. 

Name five essential oils used in dental practice. 

Oil of cloves, cinnamon, eucalyptus, wintergreen, and cajuput. 

Mention two medicines that may be used as cauteries. 

Trichloracetic acid and nitric acid or silver nitrate. 

Mention three good counter-irritants. 

Capsicum, iodin, mustard. 

Name the antacids, valuable for use in the mouth. 

Magnesium carbonate (milk of magnesia), sodium bicarbonate, char- 
coal, lime water, chalk. 

What is the chief use of capsicum in dentistry? 

As a counter-irritant and tissue stimulant. 

Describe carbolic acid and creosote, (a) Whence derived? 
(b) Their dental use. 

Carbolic acid is obtained from coal tar by fractional distillation and 
subsequent purification. When pure, it is a crystalline substance, color- 
less and possessing a strong aromatic odor and sweetish taste. Upon 
exposure to light it becomes pink or reddish. At 95 F. it changes to an 
oily liquid. Solvents are water, alcohol, ether, chloroform, fixed and 
volatile oils. 

Creosote is obtained from the distillation of wood tar. Beechwood 
makes the best creosote. When pure, it is a colorless liquid, of smoky 
odor and caustic taste. Beechwood creosote is amber in color. 

The dental uses of carbolic acid and creosote are the same; but car- 
bolic acid has superseded creosote owing to the disagreeable penetrating 
odor of creosote. The uses are: To obtund sensitive dentin; to disinfect 
and sterilize cavities, root canals and abscess sacs and fistulas; as a caustic 
for ulcers; and as a local anesthetic in slight operations, such as resection 
of gum tissue, etc. In strong solution for the sterilization of instruments 
and in weak solutions as an antiseptic mouth wash. 



CARBOLIC ACID 



249 



State three properties of carbolic acid. 

Antiseptic, caustic, local anesthetic. 



What conditions in the mouth call for the use of carbolic 
acid and what are its effects? 

As a caustic in ulcerative conditions. Sterilization of cavities in teeth, 
and, in a weak solution, as an antiseptic mouth wash. 

What is the dose of carbolic acid for internal administration? 
What are the chemical antidotes for carbolic acid? 

One-quarter to one grain. The chemical antidote is any soluble sul- 
fate, especially magnesium and sodium sulfate or dilute sulfuric acid, 
which form the harmless sulfocarbolate; alcohol. 

Mention a chemical antidote for carbolic acid. 

Magnesium sulfate. 

What are the earliest signs of poisoning from the external 
use of carbolic acid? 

Smoky discoloration of the urine, slight nervous unrest or cerebral 
disturbance, pain in the lumbar region from kidney irritation. These 
symptoms are most apt to arise after the use of dilute solutions, as in sur- 
gical dressings. The strong acid coagulates albumin and contracts the 
blood-vessels, preventing absorption. 

How may carbolic=acid poisoning be produced, and how 
treated? 

Carbolic-acid poisoning may be produced by its local application, 
especially in dilute solution, and by the ingestion of the acid or its deriv- 
atives. 

Treatment: Administer any soluble sulfate, such as magnesium and 
sodium sulfate or dilute sulfuric acid, which form the harmless sulfo- 
carbolates and also act as purges. Evacuate the stomach by means of the 
pump. Administer warm mucilaginous drinks; alcohol in the form of 
brandy or whisky; cardiac and respiratory stimulants, such as ammonia, 
atropin, and strychnin hypodermically; morphin to relieve pain; counter- 
irritation to the abdomen; and external heat. 

What is cocain hydrochlorid? How is it obtained? State 
its properties and dose. 

Cocain is an alkaloid obtained from the shrub Erythroxylon Coca. 
Habitat, Peru and Chili. By removing the tannin from an infusion of the 
shrub with subacetate of lead and then adding sodium or potassium 
hydrate till alkalinity is produced. Ether is now added and stirred, heat- 
ing to evaporate the ethereal portion. The salt is neutralized with hydro- 
chloric acid and the drug purified by crystallization from alcoholic solution. 
It is a white crystalline powder without odor and possessing a bitter taste. 
Soluble in ether, alcohol and sparingly in water. It is a local anesthetic 
and anodyne for sensitive dentin. 

Local anesthetic for removal of pulps and extraction of teeth. Dose 
1 /8 to 1 1 4 gr. For injection a 2 to 4 per cent, solution is used. 



250 MATERIA MEDICA AND THERAPEUTICS 

How do cocain and eucain differ in physiological action? 

The action of the two drugs is similar except that eucain does not 
dilate the pupil or interfere with accommodation. The effect on the circula- 
tion and respiration is less for a given dose of eucain than for cocain. 

Give maximum dose of cocain hydrochlorid for hypodermic 
administration to an adult. 

One-half grain. 

Discuss the symptoms of cocain=poisoning. 

The symptoms of cocain-poisoning are variable. Among those which 
occur are delirium, loss of speech, dilatation of the pupil, blindness, 
nausea and vomiting, syncope, and unconsciousness. The circulation 
and respiration are disordered; epileptiform convulsions occasionally 
occur. Cocain-poisoning frequently follows application of the drug to 
the urethra. 

Mention the antagonists of cocain. 

Morphin, chloral, amyl nitrite, alcohol, chloroform, and ether. 

Name a physiological antidote to cocain. 

Amyl nitrite, morphin, whiskey (alcohol). 

Give the treatment of poisoning from cocain. 

Give the patient fresh air, inhalations of amyl nitrite, and of strychnin, 
digitalis or atropin hypodermically. Doses of whiskey or aromatic spirits 
of ammonia by the mouth. Keep patient warm by artificial heat. 

What is the dose of bichlorid of mercury? 

1/32 gr. 

Mention, with doses, three coal tar preparations useful in the 
treatment of neuralgia. 

Acetanilid, 2 to 8 grs. ; antipyrin, 2 to 8 grs.; phenacetin, 5 to 10 grs. 

What alkaloids are found in opium? What is its active 
principle? 

Morphin, codein, narcotin, thebain. 
Morphin is its active principle. 

Give the antidote of the following drugs: (a) iodin, (b) 
bichlorid of mercury, (c) arsenic, (d) phosphorus. 

(a) Starch, (b) albumin, (c) freshly prepared hydrated sesqui-oxid 
of iron, (d) turpentine. 

What is the antidote for opium? 

Chemical antidote is potassium permanganate and physiologic 
antidote, strychnin or atropin. 

(a) How is opium obtained? (b) What per cent, of mor= 
phin should it normally yield? (c) Name two alkaloids of 
opium and give doses. 

(a) Opium is the concrete, milky exudation obtained by incising the 



OPIUM 251 

unripe capsules of Papaver somniferum, or poppy. (I)) Not less than 
9 per cent, (c) Morphin (sulfate) 1/4 gr.; codein (phosphate) 1/2 gr. 

Give two derivatives of morphin used in medicine, with 
dose of each. 

Heroin (diacetyl morphin): dose of the hydrochloric!, 1/24 to 1/12 gr. 
A po morphin: an alkaloid prepared from morphin by the abstraction of 
one molecule of water; dose of the hydrochlorid (expectorant), 1/30 gr; 
(emetic), i/iogr. hypodermically. 

Where is the habitat of belladonna? 

Europe and Asia Minor. 

What is the source of camphor? State the dose of spiritus 
camphorse. 

The branches and chipped wood of Cinnamomum camphora or cam- 
phor tree. Habitat: China and Japan. The wood is exposed to the 
vapor of boiling water and the volatilized camphor is condensed and 
refined by sublimation. It is also obtained by tapping the trees and 
collecting the exudate. 

Dose of spirits of camphor, 5 to 15 min. 

Name two preparations of opium. State the dose of each. 

Laudanum (tincture of opium) 10 to 30 drops. 

Paregoric (camphorated tincture of opium) 1 to 4 fluidrams. 

What preparation of iron is particularly injurious to the 
teeth? Why is it injurious? 

Tincture of chlorid of iron, because of the hydrochloric acid in the 
solution. 

In what manner may the teeth be best protected from the 
effects of acids administered internally through the mouth? 

The acids should be in dilute solution and administered through a 
glass tube. An antacid mouth wash, such as milk of magnesia, should be 
used immediately afterward to counteract the action of the acid. 

Mention the dose of (a) potassium bromid, (b) chloral, (c) 
acetanilid. 

(a) Potassium bromid, 10 to 60 grs. (b) Chloral hydrate, 5 to 
20 grs. (a) Acetanilid, 2 to 8 grs. 

Define hypertrophy of the gums. Give treatment. 

Hypertrophy of the gums is a proliferation of cellular tissue, the result 
of overstimulation, either mechanical or chemical. The treatment con- 
sists in the removal of the irritating cause of the hypertrophy and the con- 
tinued use of a strong astringent wash. In severe cases free lancing is 
indicated, and in some cases even complete resection of the hypertrophic 
tissue is necessary. 



252 MATERIA MEDICA AND THERAPEUTICS 

Describe necrosis. State some of the causes of necrosis 
and give its treatment. 

Necrosis of the bone is death of the bone due to some interference 
with the blood supply. The bone dies from lack of nourishment. It be- 
comes black and porous. There is a thin, watery formation, which exudes 
from small slit-like openings over the affected bone. 

The treatment consists in giving a free opening to the watery discharge 
and the use of an antiseptic wash. Necrosis is self limiting, forming a 
line of demarcation between the dead and living bone. When this line is 
formed, the dead bone (sequestrum) is removed and the wound packed 
with antiseptic gauze to allow the formation of granulations from the 
bottom up. 

How do chemical and physiologic antidotes differ in their 
actions? Illustrate each. 

A chemical antidote produces an insoluble or non-toxic substance with 
the poisonous substance. Example: Magnesium sulfate is an antidote 
for soluble salts of lead, as it forms insoluble lead sulfate, thus preventing 
the absorption of lead. 

A physiologic antidote does not act directly upon the toxic body, but 
produces physiologic effects opposed to those occasioned by the poisonous 
substance. Example: Atropin is the physiologic antidote to morphin, 
as it stimulates the respiratory organs which are depressed by the action of 
the morphin. 

How do corrosive poisons differ from true poisons? 

Corrosive poisons are mostly inorganic bodies which produce irritation, 
inflammation, and more or less disorganization of the parts with which 
they come in contact, as strong acids and alkalies. True poisons are those 
substances which enter the circulation and act principally on the brain 
and spinal cord, as morphin or strychnin. 

State the general principles in the treatment of cases of 
poisoning. 

Emetics or stomach pump should be used at once and general 
antidotes given, such as alkalis for acids and acids for alkalis. Special 
antidotes for the specific drug and treatment for special symptoms should 
be given as soon as possible. 

Describe the physiologic action of corrosives on tissue and 
indicate the antidotes. 

Corrosives coagulate the albumin and liquefy the tissues. The 
antidote in most cases is an alkaline salt to combine chemically with the 
corrosive, followed by oils. Alcohol applied immediately is an antidote 
for carbolic acid. Sodium bicarbonate is used as an antidote for mineral 
acids. Tannic acid is an antidote for most alkaloids. 

Differentiate atropin poisoning from poisoning by strychnin. 

In atropin poisoning there is flushing of the face, dilated pupils, 
redness and dryness of fauces, delirium, deep sleep preceded by convul- 
sions, blindness and loss of speech. In strychnin poisoning there is 
stiffness of the neck, followed by tetanic convulsions producing opistho- 



IODIN AND MERCURY POISONING 253 

tonos. The convulsions are spinal. Consciousness persists to the end. 
Death occurs from failure of respiration. 

Name two drugs whose poisonous action is markedly mani- 
fest in the mouth. Give the distinguishing characteristics of 
the effects of these drugs. 

Mercury and the iodids. 

(See following answers for symptoms). 

Describe the symptoms of hydrargyrism. 

Tenderness of the gums when the jaws are firmly and quickly closed, 
gingivitis, fetid breath, swelling of the tongue, and ptyalism. In severe 
cases the teeth drop out, the maxillary bones undergo necrosis, and eczema 
and slough of chin and chest may result from the constant dribbling of 
saliva. In some cases the nervous symptoms are predominant. Tremors 
of various kinds arise, paralysis agitans develops, and symptoms of pe- 
ripheral neuritis ensue. Blindness, deafness, sensory disturbances, 
such as hyperesthesia and anesthesia, and localized wasting of muscles 
or groups of muscles may all develop. Mercurial cachexia occurs in 
some cases. 

What are the symptoms of iodism? How may it be pre=» 
vented while the use of the iodid is continued? 

The earliest signs of this condition are a metallic taste in the mouth, 
slight tenderness of the teeth and gums, salivation, morning nausea, lack 
of appetite, perhaps coryza, and gastric irritation. Acneiform eruption 
is quite common. The patient becomes anemic and emaciated. 

Fowler's solution may modify the symptoms of this condition, espe- 
cially the eruption. 

What are the symptoms and treatment of poisoning with 
bichlorid of mercury? 

Bichlorid of mercury in toxic doses produces violent pain in the stom- 
ach, severe vomiting and purging of the contents of the bowel, mucus, and 
blood. The vomitus is white. Nephritis develops early and is usually 
severe, with hematuria. Collapse, syncope, and death. If death does 
not occur at once, it is apt to do so later from the organic changes in 
the gastro-intestinal tract, such as strictures, sloughs, destruction of the 
peptic glands, and ulcerations. 

Treatment: White of egg should be administered in large quantities as 
the chemical antidote; the stomach should then be evacuated by means of 
the stomach-pump. External heat and stimulants, such as ammonia, 
atropin, and strychnin, should be administered. 

State the name and the alterative dose of a preparation of 
mercury capable of producing acute poisoning. Mention the 
chemical antidote for this preparation. 

Hydrargyri chloridum corrosivum. Dose, 1/64 to 1/20 gr. 
Egg-albumen. 

Mention the symptoms of poisoning by phosphorus. 

Peculiar taste of phosphorus in mouth, garlicky odor of the breath, 
burning pain in the esophagus, stomach, and abdomen, vomiting and 



254 MATERIA MEDICA AND THERAPEUTICS 

purging; the vomited matter and stools are often luminous in the dark. 
The vomited matter consists first of food, then mucus, bile, and perhaps 
blood. Constipation may be present. The liver becomes enlarged, 
giving rise to pain, tenderness, and swelling. In twenty-four to forty- 
eight hours a remission often occurs, followed by a return of symptoms, 
such as jaundice, constipation, and clay-colored stools, coffee-ground 
vomit, nervous symptoms, such as headache, vertigo, muscular twitchings, 
wild delirium, and convulsions. The urine is scanty, albuminous, and 
contains sarcolactic acid, leucin, tyrosin, free fat-globules, fatty casts, 
bile acid and bile coloring-matter, and hypophosphoric acid. Wide- 
spread fatty degeneration occurs in the viscera. Chronic poisoning 
usually occurs from inhalation of the fumes; the most prominent symptom 
is necrosis of the lower jaw. 

How should phosphorus=poisoning be treated? 

Copper sulfate is the chemical antidote; but as it is almost as danger- 
ous as the phosphorus, hydrogen dioxid and potassium permanganate are 
much better and safer. All oils must be avoided, as these aid in the ab- 
sorption of the phosphorus. Opium may be necessary to combat pain 
and irritation. 

Describe the oral symptoms of scurvy and give remedial 
treatment. 

The gums become swollen, turgid and boggy, pus forms around the 
teeth, the teeth loosen and, if the disease is not checked, fall out. The 
treatment consists in changing the diet to an abundance of vegetables, 
such as salads and acidulous fruits like lemons, oranges, etc. Astringent, 
antiseptic mouth washes should be ordered. 

What is the local action of chloroform? 

Evaporating on the skin it produces a sensation of cold. Chloroform 
vapor confined against the skin acts as a rubefacient and irritant with 
anesthetic effects. 

Define narcotics, anesthetics, and sedatives, and give an 
example of each. 

Narcotics are substances which produce sleep, allay pain, and in large 
doses depress the functions of respiration and circulation. Example: 
opium. 

General anesthetics are drugs which produce total loss of consciousness, 
so that pain is no longer felt and reflex action is abolished. Example: 
ether. 

Local anesthetics are substances which, when locally applied, diminish 
or abolish sensation. Example: Cocain. 

Sedatives are drugs which depress protoplasm and lower functional 
activity. Example: bromids. 

What are local anesthetics? (b) Mention three, (c) De- 
scribe the method of using them, (d) State the precautions 
necessary. 

(a) Local anesthetics are substances which, when locally applied, 
diminish or abolish sensation. 



ANESTHETICS 255 

(b) Cocain hydrochlorate, ethyl chlorid, eucain. 

(c) Cocain and eucain are applied by injection into the cellular 
tissue by means of a hypodermic syringe. Ethyl chlorid is used in the 
form of a spray on the tissue. 

(d) Absolute asepsis of tissue and instruments is necessary in using 
the hypodermic. Care should be taken not to scrape bone with needle 
point. Antidotes should be on hand, such as atropin and morphin sulf- 
ates. When ethyl chlorid is used, the surrounding parts should be pro- 
tected with a napkin and the freezing should not be carried far enough 
to produce sloughing of the tissue. 

Name three local anesthetics used in dentistry, and state 
the conditions that call for their application. 

Cocain hydrochlorate hypodermically for extraction and minor 
operations. 

Ethyl chlorid as a spray in minor operations, extraction and fungoid 
pulp excision. 

Carbolic acid in a weak solution to alleviate pain in setting crowns, and 
in full strength to obtund a spot prior to insertion of hypodermic needle. 

What is bromid of ethyl? 

A colorless, volatile liquid, with the odor of ether. It is formed by the 
distillation of potassium bromid with alcohol and sulfuric acid. The 
purified distillate is bromid of ethyl. 

What effect on blood pressure has (a) ether, (b) chloroform? 

(a) Ether increases blood pressure, (b) Chloroform decreases blood 
pressure. 

With what class of remedies are the coal=tar products pre= 
scribed for action on the heart? 

With heart stimulants. 

Which of the general anesthetics is most depressing to (a) 
the circulation ; (b) the respiration? 

(a) Chloroform; (b) ether. 

Distinguish between narcotics and hypnotics. 

Narcotics are substances which allay pain and induce sleep, and in 
large doses depress respiration and circulation. Hypnotics are agents 
which are used to produce sleep without necessarily affecting symptoms 
of pain, but relieving insomnia where due to nervousness and allied condi- 
tions. 

Describe the preparation of nitrous oxid gas. 

By heating ammonium nitrate to 243 F. and passing the gas through a 
series of wash bottles, the first containing water, the second sodium 
hydroxid, and the third ferrous sulfate. 

Define syncope. 

Syncope, or fainting, unconsciousness produced by sudden cerebral 
anemia or lack of arterial pressure. 



256 MATERIA MEDICA AND THERAPEUTICS 

For what is amyl nitrite used, and how is it administered, 
and what is the dose? 

Amyl nitrite is a vasomotor depressant. It is used in 3 to 5 min. doses 
by inhalation, to counteract the effect of cocain or to revive a patient 
from fainting or anesthesia. 

Mention two heart stimulants that act rapidly, and give 
the dose of each. 

Ammonia, aromatic spirits, 10 to 60 min.; strychnin sulfate 1/30 
to 1/15 gr. or atropin sulfate, 1/150 to 1/75 gr. by hypodermic injection. 

Describe a method of resuscitation in case of asphyxia. 

Artificial respiration. Place patient on floor or low couch, the tongue 
being grasped and held forward by an assistant. The arms are grasped 
below the elbows and raised above the head, brought back to a position 
across the chest and pressure made. This is repeated at the rate of 
20 to 25 times a minute and continued for two hours, or until natural 
respiration is established. 

What are the therapeutic uses of sodium chlorid? 

It is administered by hypodermoclysis, intravenously, or by the rectum 
in the form of physiologic or normal salt solution containing 0.6 per cent, 
sodium chlorid, after profuse hemorrhage, the abstraction of large quan- 
tities of fluid from the body, in anemia, shock, and acute infectious diseases 
to dilute and aid the elimination of toxic material. In the form of the salt 
bath it is used to stimulate the skin and as a general tonic. 

What is an emetic? 

An emetic is an agent which causes vomiting. 

How do drugs produce emesis? 

Reverse peristalsis is caused by stimulation of the nerve endings in the 
stomach and stimulation of the vomiting center in the medulla oblongata. 

Mention three medicines used to produce emesis and state 
how each is administered. 

Zinc sulfate, dose 5 to 10 gr.; mustard, dose 1 to 4 dr. by the mouth; 
apomorphin, dose 1/10 gr. hypodermically. 

Define galactagogue and sialagogue and give an example 
of each. 

A galactagogue is a substance which increases the secretion of milk. 
Example: pilocarpin. 

A sialagogue is a substance which increases the secretion of saliva. 
Examples: pilocarpin, mercury, the iodids. 

Give an example of (a) topical sialagogue, (b) general 
sialagogue. 

(a) Mustard and ginger. 

(b) Pilocarpin and the iodids. 



CATHARTICS AND PURGATIVES 



257 



What is a cathartic, and how are cathartics divided? 

Cathartics are medicines which cause evacuation of the intestinal 
contents. They are divided into laxatives, purgatives, and drastics in 
the order of their increasing action. 

Give the dose of three saline cathartics. 

Magnesium sulfate (Epsom salt) 1/2 oz. 

Potassium and sodium tartrate (Rochelle salt) 1/2 to 1 oz. 

Sodium phosphate 1/2 to 1 oz. 

Mention three saline cathartics and state the dose of each. 

Solution magnesium citrate 12 to 14 oz. 

Sodium and potassium tartrate (Rochelle salt) 1/2 to 1 oz. 

Magnesium sulfate (Epsom salt) 1/2 oz. 

Mention with dose of each (a) saline cathartic, (b) laxative 
cathartic, (c) cholagogue cathartic. 

(a) Magnesium sulfate, 1 to 8 dr. 

(b) Cascara sagrada, 10 to 60 min. 

(c) Podophyllin, 1/20 to 1/2 grs. 

Give the physiologic action and therapy of saline purgatives. 

All strong saline solutions above the strength of 7 per 1000 abstract 
liquids from the tissues when brought in contact with them. The salines 
thus act as purgatives by abstracting water from the intestinal vessels. 
They are useful to secure depletion of the intestines, to aid in the elimina- 
tion of toxic material, and to promote the absorption of exudates and 
transudates. They are preferably given in concentrated forms and on 
an empty stomach, before breakfast. They are employed in dropsy, 
enteritis, tropical dysentery, and in all cases in which depletion of the 
intestines and increased elimination of toxic material are desirable. 

Mention a medicine whose local action dilates the blood- 
vessels of a part. 

Aconite. 

Mention a medicine whose local action contracts the blood= 
vessels of a part. 

Adrenalin chlorid. 



Name three heart stimulants administered hypodermically 
in the order of their rapidity of action and state dose of each. 

Nitroglycerin, i/ioogr. 

Alcohol, 30 to 60 min. 

Strychnin sulfate, 1/30 to 1/15 gr. 

Mention a medicine that stimulates absorption by the 
lymphatics. 

Iodid of potassium. 
J 7 



258 MATERIA MEDICA AND THERAPEUTICS 

Mention two heart stimulants administered by inhalation 
and state under what circumstances they are particularly 
useful. 

Ammonia for loss of consciousness due to failure of the heart action 
(syncope). 

Amyl-nitrite in syncope from failure of heart action during anesthesia. 

Mention two drugs that increase blood pressure. 

Digitalis and strophanthus. 

State the action of digitalis on (a) the heart, (b) the blood- 
vessels, (c) the kidneys. 

(a) Increases the force of contraction, reduces the rate and lengthens 
diastole, (b) Raises arterial tension by stimulating the muscular coats of 
the arterioles, (c) Increases the quantity of urine indirectly through 
stimulation of the heart. 

What drug is often combined with morphia when given 
hypodermically? Explain. 

Atropin sulfate is used to limit the action of the morphia, it being 
a physiological antagonist. 

Mention the dose of two of the preparations of opium and 
the dose of one of the alkaloids of opium. 

Extract of opium, 1/4 to 1 gr. Tincture of opium, 10 to 20 drops. 
Alkaloid, sulfate of morphin, 1/8 to 1/2 gr. 

Define diffusible stimulants, (b) Give three examples and 
mode of administering each. 

Stimulants that produce a prompt reaction, but whose action is of 
short duration are called diffusible stimulants. 

(b) Amyl-nitrite — inhalation. 

Ammonia — inhalation or, as aromatic spirits, by the mouth. 
Alcohol — hypodermically or by the mouth. 

State the dose, toxic effect, and antidote of arsenic, aconite, 
and morphia. 

Arsenic: dose 1/60 to 1/40 gr. 

Toxic effects are: Relaxation of the bowels, griping, pufhness beneath 
eyelids, faintness, nausea, tenderness over the stomach, flesh cold and 
clammy. 

Antidote: Freshly prepared hydrated sesqui-oxid of iron. 

Aconite: (tincture) dose 5 to 10 minims. (Revision of 1900.) 

Toxic effects are: Temperature is lowered, causing the skin to become 
cold and clammy, pupils dilated, pulse weak, tingling sensation in mouth, 
depression of respiration. 

Antidote: Tannic acid, emetics, stimulants such as brandy, atropin, 
ether, etc. Artificial warmth and artificial respiration. 

Morphin: Dose (morphin sulfate) 1/8 to 1/2 gr. 

Toxic effects are: Slowing of the pulse, depression of respiration, 
abolition of reflexes, accummulation of carbonic acid in the blood. 






VASOMOTOR DEPRESSANTS 259 

Antidotes: Potassium permanganate and tannic acid (chemical); 
strychnin and atropin (physiologic). Emetics and strong black coffee 
are valuable. 

What is meant by a synergist? Name the synergists of 
aconite. 

A synergist is an agent which aids or intensifies the action of a drug. 
Veratrum, tartar emetic and potassium bromid are synergists to aconite. 

What is the dose of tincture of aconite root? 

Five to ten minims. 

Describe the effect of aconite on the heart and name two 
other drugs which have a similar effect. 

Aconite is a strong cardiac depressant. Veratrum and antimony have 
a similar effect. 

Mention two drugs that reduce fever. 

Aconite and quinin. 

Mention (a) a remedy that antagonizes the constitutional 
action of aconite ; (b) a remedy that increases the constitutional 
action of aconite. 

(a) Digitalis, (b) Veratrum. 

What is the local action of aconite? 

It acts at first as a mild counter-irritant followed by a sedative effect 
due to paralysis of the terminal nerves. 

Name two medicines that decrease blood pressure. 

Aconite and nitroglycerine. 

How is amyl nitrite administered, and for what purpose? 

By inhalation. The perles, containing 3 to 5 min., are placed in a 
handkerchief and crushed between the fingers. 

Amyl nitrite is a powerful antispasmodic and is useful in angina 
pectoris, the convulsions of strychnin poisoning, tetanus, puerperal 
eclampsia, and infantile convulsions. It is also of value in epilepsy, 
whooping-cough, laryngismus stridulus, asthma, spasmodic croup, and 
in certain cases of cardiac failure. 

State the effect of amyl nitrite on the vascular system. 

Amyl nitrite depresses the vagus centers and causes relaxation of the 
blood-vessels, increasing the pulse frequency and lowering the blood- 
pressure by depressing the vasomotor center and relaxing the muscular 
coats of the blood-vessels. In very small amounts it stimulates the heart 
muscle, but its dominant action is depressant. 

What are the physical properties of amyl nitrite? 

Amyl nitrite is a very volatile, somewhat oily liquid, possessing a 



260 MATERIA MEDICA AND THERAPEUTICS 

peculiar fruit-like odor. It is made by the action of nitric and nitrous 
acids upon amylic alcohol. 

Describe the medicinal uses of hydrocyanic acid. 

Hydrocyanic acid is a sedative to the peripheral sensory nerves. 
It is employed in irritable stomach, nervous vomiting, gastralgia, enteralgia, 
irritable coughs, and externally in skin affections attended by itching. 

Give the physiologic action of opium. Name its most impor- 
tant alkaloids and give dose of each. 

Opium depresses the intellectual centers of the brain, producing sleep, 
and the sensorium, thus relieving pain. Reflex activity is also dimin- 
ished. Upon the circulation it has little influence in small amounts. In 
full doses it increases the force and frequency of the pulse and raises 
arterial tension by stimulating the heart muscle and its ganglia, and the 
vagi centrally and peripherally. Upon the respiration small doses are 
probably stimulant; large ones powerfully depress the respiratory center. 
The body temperature is raised slightly by full doses and lowered by 
poisonous amounts. The pupils are contracted {pin-point pupils) by 
central stimulation of the oculomotor nerves. Opium depresses the motor 
activity of the stomach and intestines and produces constipation by stimu- 
lating the splanchnic inhibitory fibers in the intestine. All secretions 
except that of the skin are checked by opium. It is a conservative of the 
tissues of the body. 

Morphin and its salts, dose 1/8 to 1/2 gr.; codein and its salts,dose 1/2 
to 2 gr. 

Where is the habitat and what are the physiologic effects 
of digitalis? 

Habitat: Europe. It is cultivated in various parts of the world. 
Digitalis stimulates the heart muscle, its ganglia, increasing the force of 
the ventricular systole and the amount of blood which enters the aorta 
and coronary arteries. It thus improves the nutrition of the heart muscle. 
It stimulates the vagus centers and the peripheral vagi, slowing the rate 
and prolonging the diastole. The vasomotor center and the muscular coats 
of the blood-vessels are also stimulated and the blood-pressure is raised. 
The diuretic action of the drug results from the increase in the amount 
of blood that passes through the kidneys, the increased heart action, and 
the relief of stasis. 

Toxic doses decrease reflex activity by stimulating Setschenow's 
reflex inhibitory center and by depressing the spinal cord. Convulsions 
occasionally occur. Finally the motor nerve-trunks are depressed and the 
muscles paralyzed. Upon the respiration it has no influence in medicinal 
amounts; toxic doses lessen the frequency. Toxic doses lower body 
temperature; high temperatures prevent the drug from acting. 

Name a vasomotor stimulant and vasomotor depressant, 
and describe the physiologic action of each. 

Nux vomica is a vasomotor stimulant, acting on the vasomotor center. 
It stimulates the motor tracts of the spinal cord, the receptive activity 
of the sensory centers, reflex activity, and in poisonous doses produces 



VASOMOTOR CONSTRICTORS 26 1 

tetanic convulsions. The frequency and force of the pulse are increased 
by stimulation of the heart muscle and its ganglia; the respiratory rate and 
vital capacity, by stimulation of the respiratory center. 

Aconite is a vasomotor depressant, acting on the vasomotor center. It 
slows the pulse and lowers the arterial tension by depressing the heart 
muscle and stimulating the vagus. The fall of arterial pressure is also 
due in part to depression of the vasomotor center. Aconite depresses 
the functional activity of the perceptive centers in the brain, the sensory 
side of the spinal cord, and the peripheral sensory nerves. The respiratory 
center is also depressed. Febrile temperatures are reduced by causing 
increased elimination of heat. The excretion of urine is augmented. 

State the local action of cocain on the blood-vessels. 

Cocain causes constriction of the blood-vessels when applied locally by 
hypodermic injection or topically. Dilatation takes place as the effect 
of the cocain wears off. 

Distinguish between a stimulant and an irritant. 

Stimulants increase the activity of a tissue or part without increasing 
the circulation unduly. An irritant stimulates a tissue or part to hyper- 
emia or inflammation. 

State the objections to the use of iron salts as styptics. 

The acidity of the iron solutions is injurious to the teeth and the clot 
formed by these solutions is soluble in saliva, causing not infrequently 
secondary hemorrhage. 

Mention the therapeutic uses of ergot of rye. What is the 
dose of the fluidextract of ergot? 

Ergot is employed for the prevention and arrest of postpartum hemor- 
rhage and for overcoming subinvolution of the uterus. It is also of value 
in menorrhagia, metrorrhagia, epistaxis, night-sweats, dysentery, serous 
diarrhea, bleeding hemorrhoids, uterine fibroids, and diabetes inspidus. 
Dose of the fluidextract, 1/2 to 2 dr. 

Give the physiologic action of ergot and mention its thera= 
peutic uses. 

Ergot produces tonic contraction of the uterus by stimulating the 
smooth muscle-fibers and the uterine centers in the lumbar portion of the 
spinal cord. It is a general stimulant to all unstriped muscle-fibers. It 
raises arterial tension by stimulating both the vasomotor center and the 
muscular coats of the blood-vessels. It is also a hemostatic, antihy- 
drotic, emmenagogue, and oxytocic. (For therapeutic uses see preceding 
question.) 

How do styptics and hemostatics differ? Give an example 
of each. 

Styptics are agents which arrest bleeding when locally applied, such 
as tannic acid and alum. Hemostatics are agents which arrest bleeding 
when administered internally, such as ergot and nitroglycerin. 



262 MATERIA MEDICA AND THERAPEUTICS 

What is formaldehyd? State the dental uses and the strength 
of solution that should be used for each purpose. 

Formaldehyd is a colorless gas of a pungent odor, intensely irritating 
to the respiratory tract. It is made by the oxidation of methyl-alcohol. 
It is soluble in water to about 40 per cent, which is the full strength 
formalin. In dentistry it is used to disinfect root canals in 1 to 2 per cent, 
solution. In mouth washes it is used in 1/4 to 1/2 of 1 per cent, solution. 

State, with reference to formaldehyd, (a) its dental uses; 
(b) the advantages of its use; (c) the objections to its uses. 

(a) As a gas to sterilize instruments and in solution (formalin) with 
other medicaments as a mouth wash, and in weak solution to sterilize root 
canals, (b) It is a most desirable disinfectant and positive in its action, 
but (c) it is irritating to the mucous membrane and the fumes or gas 
are intensely irritating to the respiratory tract. 

State what precautions a dentist should take when treat= 
ing a patient infected with syphilis. 

He should, as far as possible, have a separate set of instruments for 
such patients, and they should be subsequently subjected to formaldehyd 
gas in a closed container for at least one hour. Wood instruments should 
be used where possible and afterward burned. The operator should rub 
his hands with 25 per cent, calomel ointment before and after operating, 
working it well under the nails and into the skin until the hands are dry. 
Napkins used should be burned and towels boiled for one hour in water 
containing sodium bicarbonate. 

For what is permanganate of potassium used in dentistry? 

Caries of the bone, necrosis, diseases of the antrum, as a mouth wash 
to correct fetor of breath, and in ulcerative conditions. 

Differentiate disinfectant from antiseptic. Give illustration 
of each. 

Disinfectants are agents which destroy micro-organisms and render 
the field sterile, such as bichlorid of mercury, potassium permanganate, 
etc. 

Antiseptics inhibit the action and neutralize the toxin of micro- 
organisms, but do not always destroy; boric acid and the essential oils 
are examples. 

What desirable qualities should a disinfectant possess for 
use in a pulp canal? 

It should be positive and quick in action, should neutralize the prod- 
ucts and destroy the bacteria and spores, and penetrate the dentinal 
tubuli. 

Name three drugs useful for sterilizing instruments. De=» 
scribe a method of sterilizing a mouth mirror. 

Formaldehyd. Carbolic acid 10 per cent, solution. Bichlorid of 
mercury 7 , 1 to 1000. 

Subject the mirror to the action of formaldehyd in a closed container 
for ten minutes. 



PRESCRIPTION WRITING 263 

Arrange the following in the order of their efficiency as 
disinfectants: Carbolic acid, bichlorid of mercury, oil of cloves. 

Bichlorid of mercury, carbolic acid, oil of cloves. 

Write (a) a complete prescription for a four-ounce aqueous 
solution containing three drugs, (b) State the amount of each 
drug contained in a teaspoonful of the solution. 

(a) 1$. Tincturse aconiti f3iiss. 

Codeinae phosphatis gr. viii. 

Sodii bromidi 3ss. 

Syrupi limonis f3i. 

Aquse destillatse q. s. ad f3jv. 

M. Sig. — One teaspoonful four times a day. 

(b ) Tincture of aconite 4 + minums. 

Codein phosphate 1/4 grain. 

Sodium bromid 7 1/2 grains. 

State the rule for converting grains into grams. 

Divide the number of grains by 15.432 (the number of grains in one 
gram). 

Give a rule for determining the amount of a drug required 
to prepare a solution of a given percentage. 

Multiply the total weight of the solution in grains by the given per 
cent, and divide the result by 100. The quotient represents the number 
of grains of the drug required. 

How many grains of a drug are there in six fluid ounces of a 
10 per cent, solution? 

Six fluid ounces of water weigh 2734.2 grs.; therefore a 10 per cent. 

, . . 2734.2 
solution contams — =273.42 gr. 

Mention four disinfectants suitable for use in putrescent pulp 
canals. 

Formalin, carbolic acid, tricresol and formalin, sodium and potassium. 

Define germicide, deodorant. 

Germicides are agents which kill bacteria. 

Deodorants are agents which destroy, absorb or remove the odor of a 
substance. 

Describe potassium permanganate and give its therapeutic 
uses. 

It occurs as bluish-black crystals and is formed by mixing equal parts 
of black oxid of manganese and potassium chlorate with an excess of 
caustic potash dissolved in water and evaporated to dryness. Very 
soluble in water. It is used for fetid and gangrenous ulcerations, and is 
one of the best antiseptics for use in the oral cavity. It is also used for 
sterilization of the hands prior to surgical operations. 



264 MATERIA MEDICA AND THERAPEUTICS 

Write a prescription for a counterirritant containing three 
drugs. 

1$. Tincture aconite, 
Tincture iodin, 

Chloroform aa f 3 j. 

M. Sig. — Apply as directed. 

Describe what is meant by an aqueous solution, and write a 
prescription, giving example. 

An aqueous solution is a solution of a drug in water. 

1$. Acidi borici gr. xx, 

Aquae destillatae f 5j. 

Sig. — External use, as directed. 

Write a prescription for an antiseptic mouth wash. 

fy Phenol (95 per cent.) n\ xxx. 

Aquae q. s. ad. f . 5 v. 

Sig. — Use as a mouth wash. 

How many grains of a drug are necessary to make one pint 
of a 1 to 2000 solution? Write a prescription for a 1 to 2000 
solution of bichlorid of mercury. 

The weight of a pint of water is 7291.2 grains. One to 2000 indicates 
1 gr. in 2000 gr. water, therefore 1/2000 of a grain in 1 gr. of water. 

7201 1 

Therefore — — X = 3.6456 gr. in 1 pt. of water. 

1 2000 

1$. Hydrargvri chloridi corrosivi .gr. 3 .6456. 

Aquae f 5xvi. 

M. Sig. — Use as directed. 

Why should deciduous teeth receive early and systematic 
treatment? 

To preserve them until the time of physiologic eruption of the per- 
manent teeth, preserving the normal size, shape, and articulation of the 
arches. 

What is resorption of the roots of deciduous teeth? Is it a 
physiological or pathological condition? 

Resorption of the deciduous roots is physiologic. It is due to the 
pressure of the erupting permanent tooth causing activity of the osteoclasts. 
The phagocytic action of these multi-nucleated cells, producing a liquefy- 
ing ferment, liquefies the deciduous root, and the material is carried off 
by the lymphatics. 

In what abnormal condition will resorption of the temporary 
teeth cease? 

Abnormal eruption or impaction of permanent teeth, devitalization of 
the pulps of deciduous teeth, or suppurative conditions of pericemental 
membrane may retard or even prevent absorption of the roots of the tem- 
porary teeth. 

At what age is the first permanent tooth erupted, and which 
tooth is it? 

The first permanent or sixth year molar is erupted at or about the 
sixth year. 



EROSION AND CARIES 265 

Which of the permanent teeth are most liable to pathological 
eruption, and why? 

The third molars. The lower, owing to the lateness of eruption and 
hardness of the bone at that point; the upper, owing to the lack of 
space, are forced out by the pterygoid processes. 

What objections are there to the premature extraction of the 
temporary teeth? 

Proper space may be lost for the eruption of permanent teeth, causing 
malocclusion or possible impaction. 

What results are likely to follow abrasion of the teeth? 

Hypersensitive dentin, recession of the pulp following the formation 
of secondary dentin. 

How do you treat hypersensitive dentin? 

If in a cavity the tooth should be protected with dam and the dentin 
thoroughly desiccated with alcohol followed by hot air. If this is not 
sufficient in itself, Robinson's remedy (caustic soda and carbolic acid) 
may be applied and dried in with hot air. Cocain, carbolic acid, ethyl 
chlorid spray and sodium bicarbonate are also used with effect. 

Hypersensitive dentin at the necks of teeth or on abraded surfaces 
may be corrected with silver nitrate on the posterior, and strong tannic acid 
solutions on the anterior teeth. 

How do you distinguish erosion of the teeth and caries? 

Eroded surfaces are cup shaped and highly polished, while caries 
shows a dull granular surface or layers of leathery decay. 

Give Miller's theory of dental caries. 

The enamel is dissolved by lactic acid, formed by the breaking down 
of sugars and starches in the saliva. Micro-organisms invade the cavity 
so formed, subsist on the organic materials of the tooth substance and 
produce further decalcification by means of their acid waste products. 

What are the principles of treatment in dental caries? 

The complete removal of carious material, sterilization and her- 
metical sealing of cavity. Antacid mouth washes are used to overcome 
the action of lactic acid fermentation. 

Why is a pulp capped? When? How? 

To preserve the vitality, color and translucency of the tooth. This 
procedure is only advisable in cases where the exposure has been made by 
accident or by a burr or excavator. It is never advisable when infection 
has occurred. 

A concave disc of tin or copper is made to a little more than cover the 
exposure, filled with a paste of oxid of zinc and oil of cloves and placed 
over exposure. A thin mix of oxychlorid of zinc is flowed over the disc 
and oxyphosphate of zinc used to complete the filling. A permanent 
filling may be inserted after the lapse of a few months if the operation has 
been successful. 



266 MATERIA MEDICA AND THERAPEUTICS 

What effect may be produced on the dental pulp by contin- 
ued mild irritation? 

Continued mild irritation of the dental pulp, if insufficient to cause 
hyperemia and consequent strangulation of the pulp, might produce pulp 
nodules or the deposit of secondary dentin, owing to renewed activity 
of the odontoblasts. 

Give the differential diagnosis between pulpitis and perice- 
mentitis. 

Pulpitis is diagnosed through the character of the pain, which is severe 
and throbbing, and by the increased response to thermal changes. The 
pain is likely to be reflected or neuralgic in type. In pericementitis the 
tooth feels elongated, due to thickening of the pericementum, painful 
response to percussion, inflamed and glistening appearance of mucous 
membrane, and slight relief from continued pressure. 

Describe the pathologic changes which occur in dental pulp 
starting from irritation and ending in pus formation. 

First, hyperemia with increased flow of blood, then stasis. The apical 
foramen being minute, strangulation occurs and the blood cannot return 
through the veins. Diapedesis of the white cells now occurs, the stroma 
of the red cells is broken, and general disorganization of the tissue is 
caused by invasion of micro-organisms. The bacteria break down and 
liquefy the tissue, forming pus with the liberation of hydrogen sulfid. 

Name some of the pathological conditions of the dental pulp. 

Hyperemia, pulpitis, pulp nodules, hypertrophy or fungoid enlarge- 
ment, dry and moist gangrene. 

What symptoms indicate disease of the dental pulp? 

Pain local or reflected to the fifth nerve or some other tooth. Increase 
of pain when recumbent and excessive response to thermal changes or 
percussion. 

Give the differential diagnosis between hyperemia, inflamma- 
tion and suppuration of the pulp. 

In hyperemia the pulp responds to both heat and cold owing to pres- 
sure of the dilated blood-vessels. Intermittent attacks of odontalgia are 
present. In inflammation the response to cold is lessened, odontalgia is 
persistent and throbbing in character. Response to heat is increased. 
Suppuration occurs after infection of the inflamed pulp. Response to 
cold is nil, but response to heat is intense, producing agonizing pain. 
Owing to strangulation, throbbing ceases and the pain is steady and 
gnawing in character. 

How do you treat putrescent pulps? 

The pulp cavity should be thoroughly cleansed of decay and a 10 per 
cent, solution of formalin pumped into the canals, care being taken not 
to force detritus through the apical foramen. Kalium-natrium (sodium 
and potassium) should now be worked into the canals on a smooth broach. 
Saponification of the fats and oils takes place accompanied with ebullition. 
The canal contents may now be washed out with warm sterile water and 



ALVEOLAR ABSCESS 267 

the canals further sterilized with zinc chloric!. A dressing of carbolic 
acid and iodoform should be sealed in for a few days before inserting 
permanent filling. • 

What causes induce periodontitis? 

Septic infection, traumatism, salivary or serumal calculus, irritation 
from clamp, band, regulating appliances, etc. 

What is the danger of chronic, septic pericementitis, and 
what is the treatment? 

The dangers are absorption of septic material by the blood, necrosis of 
the bone or tooth and opening of a fistula on the face or neck. The 
treatment consists in thorough evacuation of the pus and sterilization 
with carbolic acid. The latter has the added effect of stimulating the 
cells to produce granulation. 

What is phagedenic pericementitis? 

It is a disease of the pericementum accompanied by bacterial invasion, 
necrosis of the membrane and grave danger of septic intoxication. 

How are the diseases of the pericementum diagnosed from 
those of the pulp? 

Diseases of the pericementum respond to pressure and not to the ther- 
mal test, while the reverse is true of diseases of the pulp. Pericemental 
disorders may be diffused or reflected and located only with difficulty. 

How would you differentiate between pericementitis and 
alveolar abscess? 

In pericementitis there is a thickening of the pericemental membrane 
causing elongation of the tooth. The tooth is sensitive to percussion, 
but the pain is frequently relieved by firm, steady pressure. The pain 
is never severe and the swelling is never great. In alveolar abscess the 
pain is severe, pressure gives no relief, the swelling is great, and pus is 
present in greater or lesser quantities. 

What causes an alveolar abscess? 

Bacterial invasion of an area of lowered vitality caused by inflammation. 
The inflammation may be due to irritation of serumal tartar, or to the 
pressure of gases from a putrescent pulp, or even the direct action of septic 
material forced through the apical foramen. 

What dangers are to be apprehended from abscess upon 
the temporary teeth? 

Interference with the action of the follicle of the permanent tooth, 
tardy absorption of the roots of the devitalized deciduous tooth or the 
possible necessity of extraction, followed by malocclusion of the permanent 
tooth. 

Which tissue of the tooth dies with the pulp and which 
remains alive? 

The dentin dies with the pulp, the cementum, receiving its vitality 
from the pericementum, remains alive. 



268 MATERIA MEDICA AND THERAPEUTICS 

How is pulp irritation from loss of tooth substances distin= 
guished from sensitive dentin? 

Extreme response to contact of instruments on the abraded surface 
indicates hypersensitive dentin. Slight response to contact of instru- 
ment and marked response to the thermal test indicates pulp irritation. 

What causes superinduce the devitalization of non=carious 
teeth? 

Too rapid separation or moving of teeth, a severe blow, extreme heat 
or cold, may cause devitalization following hyperemia and strangulation 
of the pulp. 

Give some causes of necrosis. 

Cutting off of the blood supply to a part by strangulation of an artery 
or a thrombus, separating the periosteum from the bone, continued pres- 
sure on a part. 

Describe epulis within tooth cavity. Describe fungoid pulp. 

Epulis within a tooth cavity is a hypertrophic growth of the soft 
tissues, through a perforation of the root, into the pulp chamber. Fun- 
goid pulp is a hypertrophic, fibrous, vascular enlargement of the pulp 
tissue, extending into and often filling the cavity of the crown. 

Describe and give the supposed cause for Hutchinson's teeth. 

They present a shortened, peg-shaped appearance and are notched or 
pitted on and near the cutting edge. The supposed cause is congenital 
syphilis. 



HYGIENE 






Define hygiene. 

Hygiene is the science of the preservation of health and prevention of 
disease. 

Define humidity of the atmosphere. Why should a humid 
atmosphere cause rheumatic persons and persons suffering 
with gout increased sensitiveness? 

Humidity is the amount of vapor of water in the air. Increased hu- 
midity increases the sensitiveness of gouty and rheumatic patients by dimin- 
ishing the elimination through the skin of organic matters and uric-acid 
derivatives, which results in retention of these poisons in the system. 

Describe the effect of a hot and moist climate on the human 
system, and state the class of diseases this atmosphere is likely 
to induce. 

Inhabitants of hot, moist climates are of small stature, deficient 
muscular development, nervous temperament, and languid disposition. 
The most prevalent diseases are malaria, yellow fever, cholera, and affec- 
tions of the liver and gastro-intestinal tract. 

How do forests benefit public health? 

They afford protection against winds, increase the quantity of oxygen 
and ozone, especially pine forests, in which the aromatic substances given 
off may also possess an antiseptic influence and absorb carbon dioxid. 
Their general effect is tonic and stimulating. The difference between 
the day and the night temperature is less marked. 

What conditions of ill=health make residence in high 
altitudes dangerous? Why? 

Affections of the heart, kidneys, and lungs, especially the late stages 
of consumption; emphysema and arteriosclerosis (old age). The rarefied 
condition of the air causes increased respiratory and cardiac action. 

What localities should be sought or avoided by rheumatic 
patients? 

A warm, dry, equable climate is most suitable. Dryness of the air is 
more important than the absence of cold. Localities with alkaline or 
sulfur hot springs are desirable. 

Dampness, valleys shut in on all sides, the vicinity of large rivers and 
the seacoast, and all localities exposed to high winds and sudden changes 
of temperature should be avoided. 

269 



270 HYGIENE 

Mention six desirable factors in the location of a resort for 
consumptives. 

An equable climate, moderate altitude, a dry atmosphere, pure air, 
abundant sunshine, and pure water. 

Give a fair average death=rate (a) in rural districts, (b) in 
towns of from 5000 to 20,000, and (c) in cities of over 100,000 
inhabitants. 

(a) 14, (b) 17, (c) 21 per 1000. 

Why and how is carbon dioxid deleterious to health? 

In itself it is not injurious in ordinary proportions, from 0.03 per cent, 
in pure open air to 0.6 or even 1.0 per cent, in closed rooms. Carbon 
dioxid is an indicator of the quantity of organic impurities present in the 
air. A larger proportion of artificially prepared carbon dioxid can be 
tolerated than of carbon dioxid resulting from animal respiration. 

Compare, in reference to danger to health, carbon monoxid 
with carbon dioxid. 

Carbon monoxid is a direct poison and very destructive to animal life; 
carbon dioxid is dangerous chiefly because it displaces oxygen, which is 
essential to life. The proportion of carbon dioxid in air is an index of 
the quantity of noxious organic impurities present. 

How much fresh air is required by an adult for normal res- 
piration during twenty=four hours? 

3000 cubic feet per hour, or 72,000 cubic feet in twenty-four hours. 

What deleterious gases accumulate in improperly ventilated 
sleeping=rooms? 

Carbon monoxid, carbon dioxid, hydrogen sulfid, and ammonium 
sulfid. 

What are the necessary hygienic conditions of a model 
sleeping=room? 

The height of the apartment should be nine feet, the floor space sixteen 
square yards. Twenty-five cubic yards of air space must be allowed for 
each occupant. The temperature in winter should not be above 68° F. 
The room must have at least one window, equal in area to at least one- 
tenth of the floor space, and opening half its size. Metal bedsteads are to 
be preferred, furnishings should be few and simple, and all dust-collecting 
hangings should be banished from the room. The cleansing of the room 
must be systematic and thorough. The ideal method is the "vacuum," 
which is now employed in the most modern hospitals. 

What is the proper temperature for a living=room in winter? 

68° to 70 Fahrenheit. 

State the results to animal life of the combustion of fuel in 
a room without chimney connection or other ventilation. 

Carbon monoxid poisoning and asphyxiation, due to excess of carbon 
dioxid and lack of oxygen. 



VENTILATION 27 1 

Describe a simple method of ventilating the sick-room. 

In winter place a wooden strip, three inches wide and as long as the 
window-frame is wide, under the lower sash; through the space between 
the top of the lower and the bottom of the upper sash, enough air will enter 
the room. In summer open the windows from the top. Be careful that 
the patient is protected from drafts. 

What are the methods of ventilating dwellings? What 
sanitary principles are involved? 

Methods of ventilation vary with the size and character of the building 
to be ventilated, the number of occupants, the exposure, the necessity for 
artificial heating, and similar factors. They may be divided into natural 
and artificial. In natural ventilation the diffusion of gases and the move- 
ments of the air caused by wind, and especially by inequalities of tem- 
perature, are utilized. Artificial ventilation is effected by the employment 
of apparatus to displace vitiated air by fresh air, either through the action 
of heat or by mechanical means such as pumps (forced ventilation), jets, 
fans, bellows, and the like (propulsion). 

In ventilating an occupied room, where should the inlets 
and the outlets be placed? 

The inlets near the floor, and the outlets near the top. 

Give an opinion as to the sanitary effect of the different 
methods of heating houses. 

The hot-water system is the best, but it is expensive and a skilled man- 
is required to look after it. It does not furnish warm, moist air, as is 
generally supposed, and the temperature can easily be regulated. No 
injurious products of combustion escape into the room, and, when indirect 
radiation is employed, no artificial ventilation is required. Radiation is 
called direct when the steam or hot-water radiators are placed inside the 
room; indirect when they are entirely outside, the heated air entering 
through flues. When the radiators are partly inside and partly outside, 
the room is said to be heated by direct-indirect radiation. 

Next in value, from a sanitary standpoint, is steam heating by direct or 
indirect radiation. The disadvantage is the difficulty of regulating the 
degree of heat. 

Open fire-places are very good ventilators, but yield an unequal and 
insufficient supply of heat; they also cause drafts in cold weather. 

Hot-air furnaces and stoves are efficient if the air supply can be kept 
pure. Ventilation is necessary, however, and gases will leak from the 
fire-box into the hot-air chamber. 

What effect have ground air and water on the health? 

Ground air is always impure from contamination with bacteria, carbon 
dioxid, and other deleterious gases. It causes a decrease of vitality and 
is a means of spreading disease. 

Ground water from near the surface of polluted soils contains numer- 
ous bacteria and products of decomposition. It predisposes to catarrhal 
and rheumatic affections and contains the germs of infectious diseases. 



272 HYGIENE 

In the selection of a site for a dwelling what is the best soil, 
subsoil, and topography? 

A light, dry soil with a nearly constant level of ground water. Both 
the soil and the subsoil should be free from clay and other impermeable 
material. Low-lying ground and any locality where water collects should 
be avoided in the selection of a building site. The side of a hill, with 
a southern or southeastern exposure, is preferable to the top of an elevation. 

Mention the danger of excessive shade about dwellings. 

It interferes with the free movement of air, prevents the entrance of the 
sun's rays, diminishes evaporation, and keeps the dwelling damp. 

State what hygienic measures a dentist should employ after 
operating at a chair. 

After thoroughly scrubbing the hands with hot water and soap, using 
a stiff brush, they may be washed in some antiseptic preparation, prefer- 
ably alcohol, or alcohol and aromatic spirits of ammonia. Nose, throat 
and mouth should be sprayed with an alkaline wash or simple salt solu- 
tion. All instruments used at the operation are to be at once sterilized 
according to accepted methods, and the room thoroughly aired. 

Give the special hygiene of factories in which women and 
children are employed. 

Sufficient air space must be allowed for each person employed to insure 
a supply of from 60 to 100 cubic meters of fresh air per hour. Thus, if 
the ventilation is such that the air is renewed three times in an hour, the 
amount of air space per individual must be from 20 to 35 cubic meters. 
Suitable ventilators that will carry off dust as well as vitiated air and 
injurious gases must be installed. The temperature should be about 65 
Fahrenheit. Ample and properly constructed wash-rooms and water- 
closets with modern plumbing must be provided. 

What hygienic care should be given to an operating-room? 

The chief requisites are good illumination, natural if possible, obtained 
by a suitable, northern exposure, and adequate ventilation. Hot water 
heating is to be preferred to the hot air system because the air is freer from 
dust. The walls, floor and ceiling should be susceptible of being easily 
cleansed, and unnecessary hangings, rugs, etc., reduced to a minimum. 

What measures, including diet and medication, should be 
used on shipboard or in camp to eradicate scurvy? 

The diet must contain some fruit and vegetables, and salt foods should 
be reduced to a minimum. The men must be made to bathe frequently, 
and on shipboard spend some time on deck every day. Medicinally, 
lemon-juice, vinegar, and tonics, with a potassium chlorate mouth wash, 
are indicated. 

Mention the properties necessary in ordinary drinking- 
water. 

Purity and palatability . The first is secured by providing a suitable 
source of supply and protecting the water against subsequent contamina- 
tion with sewage, factory waste, etc. Drinking-water should not be too 



WATER 273 

hard nor too soft. Hardness depends on the proportion of mineral salts, 
especially calcium and magnesium salts, and IS determined by the be- 
havior of the water when brought in contact with soap; the softer the water 
the more readily it forms a lather. Very soft water, like rain water, while 
excellent for washing purposes, is flat and therefore unsuitable for the 
table. 

What constitutes hard water and soft water? 

Hardness is the capacity water has to dissolve soap, and depends on the 
amount of magnesium and calcium salts in solution. Soft water contains 
little or no dissolved salts and rapidly forms a lather with soap. 

What conditions are essential to a good water supply? 

Purity at the source and adequate subsequent protection against con- 
tamination; constancy of supply and practicability of artificially increasing 
it, if necessary, and opportunity for storing. The water should not be too 
hard. Hard water cakes the boilers in manufacturing plants, and this 
may cause explosions. 

What is the temperature of tepid water? Of hot water? 
Of boiling water? 

Tepid water, 8o° to 90 F.; hot water, ioo° to no°; boiling water, 212 . 

What are the chief sources of contamination of drinking^ 
water? 

Sewage emptied into the stream from which the supply is obtained; 
surface w r ater in settled districts gaining entrance to the supply; subsoil 
water, after passing through infected soil; drainage from cemeteries and 
from soil containing mineral poisons; lead pipes. 

Describe the several methods of purifying drinking=water. 

Sedimentation, allowing the water to remain at rest for a time, is used 
in connection with other methods. The suspended matter at least is 
removed, and the water is cleared. 

The best filters for domestic use are Pasteur's and Berkefeld's. Other 
filters are made of stone, unglazed porcelain, or charcoal, need frequent 
cleansing, and act merely as mechanical strainers. Water that has passed 
through the ordinary filter must be boiled if pathogenic bacteria are to be 
removed. 

Sand Filtration. — The water is made to flow through prepared beds of 
sand and broken stone. The action is both mechanical, removing the sus- 
pended matter, and chemical, as oxidation of organic matter and bacte- 
ria goes on in the superficial layer {felt top). As the natural pellicle is 
soft, certain substances, such as alum and iron (scrap iron), are added to 
harden the filter and increase its resistance to pressure. A properly con- 
structed sand filter should allow not more than 300 germs in a centimeter 
and no organic matter to pass through. 

If a chemical analysis of water revealed the presence of 
nitrites and nitrates, would this condemn it for drinking pur= 
poses? If so, why? 

Yes, especially if nitrates are present. Organic matter, particularly 
18 



274 HYGIENE 

sewage, is converted first into nitrites and then into nitrates by the action 
of bacteria; hence the presence of these substances indicates the previous 
pollution of the water. 

Name three tests for detecting impurities in water. 

Nessler's test for detecting and estimating the amount of ammonia, 
the nitrate of barium test for sulfates, and the nitrate of silver test for 
chlorids. 

What diseases are propagated by drinking- water? How 
can their spread be prevented? 

Typhoid fever, cholera, and dysentery ; diseases due to animal parasites 
(except malaria) and to mineral poisons (lead) . Their spread can be pre- 
vented by prohibiting the use of unfiltered or unboiled water and of water 
containing mineral poisons in solution. 

What are some of the dangers involved in the domestic use 
of ice? 

Ice may contain pathogenic bacteria and ammonia. 

Give the prophylaxis of the filth diseases. 

Sanitary inspection of all houses and other buildings, with immediate 
abatement of any nuisance discovered. Examination of the water and 
food supply. Thorough inspection of closets, sewers, and the disposal 
of garbage and other waste. Isolation of patients and disinfection of 
dwellings and personal property of such patients. The establishment of 
house, municipal, state, or national quarantine. Protection against flies 
and other insects. 

What are the sanitary requirements of house plumbing? 

Each house must be connected directly by pipe with the common sewer. 
The piping in the house must be of iron, with screwed couplings, and in 
plain view. The drainage-pipe should have a drop of i in. in every 4 ft., 
and should be provided with a trap, placed beyond all inside connections. 
The water-closets, bath-tubs, wash-bowls, and sinks must have tight joints 
and must also be provided with traps and trap ventilators. Soil-pipes 
must have ventilators extending at least 2 ft. above the roof. 

What is the best means of preventing the access of sewer 
gas to dwellings? 

Place a trap or water-seal between the house drain and the sewer, and 
provide an air inlet pipe into the drain between the trap and the house. 
The ventilator pipe should extend from the house drain at least 2 ft. above 
the roof. 

Mention some of the objections to storage cisterns under 
ground. What are the objections to rain water as a drink? 

Storage cisterns are usually dirty, difficult to clean, and cannot be 
properly ventilated. The water in the cistern may be contaminated when 
the overflow pipe is connected with the drain or soil-pipe of a house. 

Rain water is insipid; the first part collected contains dust, pollen, and 
other matters derived from the air. The supply cannot be regulated. 



DISPOSAL OF SEWAGE 275 

Define the word "nuisance" in a broad hygienic sense. 

Anything that actually injures, or is likely to injure health, and admits 
of a remedy either by the individual whose act or omission causes the 
nuisance or by the local authorities. 

Name some of the nuisances dangerous to health. 

Gases and dust of an offensive, irritating, or poisonous nature emanat- 
ing from industrial establishments or refuse. Smoke from factories and 
railroads. Collections of stagnant water, garbage, and animal matter 
exposed to the air. Industries that give rise to great noise or vibration in 
thickly settled communities. 

How may a privy in the city or country be kept from becom= 
ing a nuisance while in use? 

A disinfectant and deodorant substance, such as chlorid of lime, should 
be poured into the privy vault every few days, and the vault emptied at 
short intervals. Ventilation must be secured by means of a pipe extending 
from the vault to the top of the privy. 

Mention some of the objections to curbed or driven wells in 
streets or houses, with respect to the purity of water coming 
from these wells. 

The curbing rarely affords adequate protection to the well-water 
against contamination from sewers and gas-pipes. In driven, piped 
wells the water is taken from far below the surface, and in city streets 
the soil is so contaminated with noxious material that the water is in 
danger of pollution. 

What is the most sanitary way of disposing of city garbage? 

Incineration. 

What is the best sanitary plan for the disposal of sewage? 

Collect the sewage in large tanks and add lime to it. Compress the 
solid material after its precipitation and incinerate. Allow the liquid 
sewage to flow upon specially prepared filter beds, which are subdrained; 
the water coming from these drains may then be allowed to flow into a 
stream without great danger of contamination. 

State the advantages of cremation over earth burial. 

The danger of contaminating the water supply in the vicinity of ceme- 
teries is obviated, as all disease germs are completely destroyed. 

What care should be employed in exhumations? 

The exhumation of those dead of a contagious disease should be for- 
bidden. Whenever possible, exhumation should be done in cold weather; 
the presence of all persons except those absolutely needed should be for- 
bidden, and the coffin should not be opened, but placed at once in a 
zinc-lined box and sealed. 



276 HYGIENE 

State the average weight of feces in twenty-four hours in 
a normal man. What proportion is made of liquid, and what 
of solid contents? 

From 6 to 8 oz., of which 75 per cent, is liquid. 

What do you understand by the "dry earth system" as 
applied to excrementitious matter? 

The discharges are received in a box containing dry earth, and, after 
using the privy, fresh earth is added from a " hopper." The receptacle 
is emptied from time to time, and fresh earth placed in it. 

What is sewer gas? How does the inhalation of sewer gas 
in large quantities affect the system? 

Sewer gas is a mixture of a number of gases — carbon monoxid, also 
carbon dioxid, ammonium, and hydrogen sulfid — resulting from the 
decomposition of animal and vegetable matter. In itself, sewer gas does 
not cause disease, but if it is present in the air in sufficient quantities it 
acts injuriously by the deprivation of oxygen, causing anemia and other 
conditions due to deficient oxygenation. 

The excavation of streets in cities is frequently followed by 
the outbreak of diseases, such as diphtheria and typhoid fever. 
What is the cause? 

When the ground is broken and the soil exposed to the air, the con- 
tained pathogenic bacteria are set free by the drying out of the soil and 
scattered by the wind, or gain entrance to the food or water supply and 
cause disease in susceptible individuals. 

What hygienic precautions are necessary to insure healthy 
sleep? 

Adequate ventilation and a room temperature of about 6o° F. ; absence 
of light and freedom from noise; clean bed-linen and blankets sufficient to 
keep the sleeper warm without overheating. The head may be elevated 
by resting on one pillow. Feather beds should be avoided. 

What are the respective merits of cotton, wool, and silk, 
when used for underwear? 

In variable weather wool is preferable, because it is a non-conductor 
of heat and hygroscopic ; woollen underwear thus tends to retain the body- 
heat by absorbing the moisture of sudation, prevents evaporation, and 
sudden chilling of the body. For this reason, woollen underwear is the best 
in a variable climate and wherever the difference between day and night 
temperature is very great. Next to wool, silk is the best non-conductor, 
and the softness of its texture recommends it to those who can afford the 
relatively high cost. In a warm, equable climate cotton underwear, which 
retains the heat less than wool and silk, and has the advantage of cheapness, 
is quite satisfactory. 

State the value of public baths to the health of a large city. 

Besides giving those who desire it an opportunity to keep clean, they 
encourage cleanliness among the inhabitants, generally, and thus serve 
to prevent or at least diminish filth diseases. 



OCCUPATION DIS1 277 

What are the hygienic requirements and physiologic effects 
of bathing? 

The bath should be taken on arising, or not less than two hours after 
a meal. A cold bath, taken for its tonic effect, should be of a temperature 
of about 65 degrees F., and the duration about live minutes. The surface 
of the body should be rubbed briskly with the hands or bathing mitts, 
and afterward thoroughly dried with a rough towel until a good reaction, 
shown by redness of the skin, is obtained. The effects following a bath 
are the removal of dirt and dead epithelium, stimulation of the function 
of the skin, increased activity of the circulatory and respiratory organs, 
and a general tonic effect on the nervous system and on metabolism. 

What physical conditions would render the taking of a Turk= 
ish bath inadmissible? 

General arteriosclerosis; diseases of the heart and lungs. 

Mention some of the diseases to which artisans are especially 
liable. 

Lead, arsenic, copper, and phosphorus poisoning; pulmonary and 
bronchial affections from the inhalation of coal dust and other kinds of 
dust (miners, glass-blowers, etc.); emphysema from constant, excessive 
distention of the lungs (cornet players, glass-blowers). 

In the pursuit of what trades is there a predisposition to 
pulmonary diseases? 

All those trades which have to be carried on in ill-ventilated and over- 
crowded rooms or in damp quarters (sweat-shops, etc.) ; those which are 
attended with the production of dust and of noxious gases; glass-blowing. 

Mention the effects of working in phosphorus, as in the 
manufacture of phosphorus matches. How can the dangers 
be limited or obviated? 

Phosphorus fumes produce necrosis of the inferior and superior maxillae 
particularly in persons with carious teeth. The danger arising from 
this source may be minimized by careful attention to the condition of the 
teeth and the systematic use of a mouth wash consisting of lime-water 
and sodium bicarbonate, as well as cleanliness of the body generally, 
particularly the face and hands. The factory should be provided with 
forced ventilation, so that the fumes are carried off as fast as they are 
produced. 

Name four diseases that are communicable to man through 
cows' milk. 

Typhoid fever, tuberculosis, diphtheria, and scarlet fever. 

Mention some of the advantages of carefully prepared 
artificial ice as compared with natural ice. 

If the proper precautions are observed in its manufacture, artificial ice 
is free from bacteria and inorganic impurities (lead, iron, etc.). The 
cakes may be frozen in any desired size and shape. Artificial ice plants 
can be established anywhere — in hospitals and other institutions — thus 



278 HYGIENE 

insuring a constant supply of ice without dependence on local ice com- 
panies. 

Describe the agency of the ptomains in inducing diseases, 
and the disorders produced by them. 

Ptomains are poisonous bodies produced during the decomposition 
of nitrogenous substances. They are derived from partially decomposed 
animal food, especially canned meats, and when absorbed in the body 
give rise to a condition known as ptomain poisoning, characterized by 
headache, fever, nausea, vomiting and diarrhea, torpor, and at times a 
fatal termination. 

What precautions as to food and drink should be observed 
by those forced to work under the direct rays of the sun in 
summer weather? 

The diet should be light and consist chiefly of vegetable food. Meats 
and all heavy articles of food should be avoided until the day's work is 
done. Water and other non-alcoholic beverages may be taken freely; 
malt and distilled liquors must be avoided. 

What is understood by the germ theory of disease? Mention 
all diseases whose causes are known to be micro=organisms. 

According to the germ theory, the exciting cause of every infectious 
and contagious disease is a micro-organism, and such diseases are com- 
municated only by the invasion of the particular germ and its develop- 
ment in or upon the tissues of the infected individual. 

The diseases due to specific micro-organisms are: tuberculosis, pneu- 
monia, influenza, typhoid fever, typhus fever, relapsing fever, epidemic 
cerebrospinal meningitis, cholera, dysentery, diphtheria, tetanus, ery- 
sipelas, gonorrhea, and syphilis, leprosy, anthrax, and glanders. 

Differentiate between endemic and epidemic diseases. 

An endemic disease is one which is more or less constantly present in a 
certain district or locality. An epidemic disease is one which appears 
suddenly and attacks many persons at the same time. 

(a) To what diseases are negroes comparatively insuscep=» 
tible? (b) In the Middle States to what diseases are negroes 
more prone than whites? 

(a) Yellow fever, dysentery, and diseases resulting from great heat. 
(b) Small-pox, respiratory diseases, fibroid tumors, keloid, syphilis, and 
tuberculosis in all its forms. 

Mention five preventable diseases. 

Small-pox, yellow fever, typhoid fever, pulmonary tuberculosis, 
cholera, and malaria. 

Name and describe the methods of transmission of the most 
important infectious and contagious diseases. 

The specific micro-organisms may gain entrance to the body (1) 
through the respiratory system, as in pulmonary tuberculosis, pneumonia, 



PREVENTION OF CONTAGION 279 

influenza, and diphtheria; (2) through the alimentary tract, as in typhoid 
fever, dysentery, and cholera; (3) by contact, as in small-pox and the acute 
eruptive fevers (probably), in gonorrhea and syphilis, and in leprosy; (4) 
by inoculation, the micro-organism entering the blood, as in malaria, 
erysipelas (probably), and tetanus. 

Diseases due to the invasion of the intestinal tract by the specific micro- 
organism are usually caused by drinking infected water or milk, or by 
eating uncooked food, such as salads and fruit, oysters, etc., contaminated 
with infected water. Contagious diseases may be acquired by direct 
contact with the patient or indirectly by contact with clothing or other 
fomites infected with the germs. 

What are the principal measures which you would employ 
for the prevention of the spread of infectious diseases? 

Disinfection of all discharges and everything that has come in direct 
contact with the patient. Soiled linen should be disinfected before being 
washed. The patient should have separate eating utensils. In the case 
of contagious diseases isolation of the patient and nurse, who must not 
leave the sick-room without first cleansing hands and face with an anti- 
septic solution and removing the clothing worn while attending the patient. 
In the case of small-pox strict isolation of both patient and nurse and 
quarantine of the entire household are necessary. To prevent the spread 
of a water-borne disease all persons should be enjoined to drink only 
boiled water. 

What precautions should a physician observe to avoid carry- 
ing contagious diseases? 

Before entering the sick-room the physician should put on a gown or 
linen duster long enough to cover the entire body; the trousers may be 
turned up and the hair protected with a cap, leaving only the face, the 
hands, and the feet uncovered. Rubber gloves may be worn. In ex- 
amining the patient contact of any part of the body except the hands with 
the patient or bed-clothes must be avoided. Immediately after leaving 
the sick-room, wash the face and hands thoroughly with soap and water 
and disinfect in carbolic acid or bichlorid solution; then remove cap and 
gown. The nurse should be instructed to saturate cap and gown with 
bichlorid solution once a day. 

What are the most common sources of infection in diphtheria? 

Direct contact with the sputum or shreds of membrane coughed up by 
a diphtheritic patient; contact with fomites: clothing, books, drinking- 
cups, and the like. 

What hygienic precautions should be employed about diph= 
theria? 

Isolation of patient until convalescence is completed, as shown by 
two negative cultures from the affected area on consecutive days. Only 
those whose presence is absolutely necessary must be allowed to enter the 
sick-room, and they must wear gowns and caps. The patient's excre- 
tions must bedisinfected and dressings, if there are any, burned. The 
members of the household should be quarantined, and should receive a 



280 HYGIENE 

prophylactic injection of antitoxin. After the patient has recovered, the 
sick-room and contents are disinfected. 

How long does a diphtheria patient remain infective? How 
may it be proved that this infective period has ceased? 

From two to three weeks after the disappearance of local symptoms. 
When two successive cultures from the affected area, made on different 
days, fail to show the specific bacteria, the patient is no longer a source of 
infection. 

Can it be proved that the diminished death=rate from diph- 
theria so generally announced is due to the use of diphtheria 
antitoxin? Give reasons. 

Yes. By comparing the death-rate in two wards of the same hospital, 
in one of which diphtheria antitoxin is used while it is withheld in the 
other, the death-rate is found to be much lower in the former. 

State the objections usually advanced against vaccination 
as a preventive of small=pox. 

It is stated that vaccination fails to protect against small-pox, that it may 
cause blood-poisoning, and that there is danger of transmitting diseases, 
such as syphilis and tetanus. The latter, especially, it is objected, 
may have been present in the horse from which the virus is obtained. 

Which, in your judgment, is to be preferred in vaccination, 
animal or humanized lymph, and why? 

Animal lymph; because greater care to insure freedom from bracteria 
is possible, and because the supply can be more readily controlled. Syph-' 
ilis cannot be transmitted by animal lymph. 

State the accepted belief in respect to the limitation of pro= 
tection from vaccination. 

The period of protection is generally believed to last about seven 
years, at the expiration of which revaccination should be tried. During 
a small-pox epidemic it is advisable to revaccinate all persons who have 
not been vaccinated within three years. 

Describe in detail the sanitary precautions necessary in 
typhoid fever. 

The stools, urine, vomit, and sputum should be disinfected with a so- 
lution of chlorinated lime (6 oz. to a gallon of water). Towels, napkins, 
bed-linen, and all clothing used by the patient must be disinfected with 
a 5 per cent, solution of carbolic acid or i to iooo bichlorid solution before 
removal to the laundry. The nurse must be careful to wash and dis- 
infect the hands each time after attending to the patient's wants. Fumi- 
gation is advisable after the patient has been removed from the sick-room. 

Through what media is the typhoid poison usually commu= 
nicated? 

Drinking-water; also milk, oysters, and green vegetables that are eaten 
raw. In each case it is the water in contact with these foods that contains 
the bacteria. 



MALARIA 28l 

Describe in full the causes of malaria and its prevention. 

The cause of malaria is an animal parasite, commonly called Plas- 
modium malaria, although, since it is not found in the plasma, but in 
the corpuscles, it should be properly called a hemameba. The inter- 
mediate host of this parasite is the mosquito of the genus Anopheles, 
which obtains the spores from infected human beings and transmits them 
by biting other individuals. The definitive host is man. The parasites 
invade the red blood-corpuscles, absorb the pigment as they grow, becom- 
ing themselves pigmented, and, when fully matured, undergo segmentation 
with the production of large numbers of spores. Rupture of the parasites 
liberates these spores, which enter other corpuscles and develop into 
mature parasites, repeating the cycle of development, which varies in 
length, according to the species (tertian, quartan, estivo-autumnal, etc.). 

The prophylaxis of malaria consists in preventing the inoculation of 
individuals by mosquitos. The latter are carriers, but never the orig- 
inators of the disease. The measures that have been advised are: 1. 
Destruction of the breeding places of mosquitos by draining or filling up 
pools of stagnant water and by screening all open receptacles, such as 
cisterns and water barrels. 2. Prevention of mosquito contamination by 
screening from the insects all those affected with the disease, or by rapidly 
removing the parasites from the peripheral circulation by the proper 
administration of quinin. 3. Withdrawal to a distance of from five to 
six miles from localities where cases of malaria are present. 4. Prevent- 
ing the multiplication of the parasites by the continuous exhibition of 
small doses of quinin. 

How can malarial districts be made healthy? 

By preventing the development of the mosquito larvae by ditching and 
draining the breeding grounds and by the liberal use of petroleum where 
drainage is impracticable; by screening all houses in which malarial 
patients are confined. Eucalyptus trees are said to afford some protection 
against mosquitos. 

What rules in public health administration should be pro= 
mulgated to prevent the spread of pulmonary tuberculosis? 

Expectoration on sidewalks and on the floors of all public places and 
public conveyances should be prohibited. Houses that have been in- 
habited by tuberculous inmates should be disinfected. All tuberculous 
cattle should be condemned and killed. Persons suffering from tubercu- 
losis should not be allowed to prepare or distribute food. 

How should a room recently occupied by a person suffering 
with tuberculosis be disinfected? 

The room should be closed hermetically and thoroughly disinfected 
with formalin, after which the walls should be repapered or painted. 

What principal hygienic direction should be given to a 
patient suffering from tuberculosis? 

To live in the open air practically all the time and to drink at least three 
pints of milk and eat fresh meat once a day, or from six to ten eggs daily; 



282 HYGIENE 

to expectorate into a paper spit-cup or some other appliance that can be 
burned; to avoid kissing and close bodily contact with other persons. 

State the best means of disinfecting sputum. 

The sputum should be received in a paper spit-cup, set in a metal box 
with a lid. The spit-cup is taken out of the container, burned, and 
another put in its place. Or, the sputum may be discharged into a china 
or enamel cup provided with a lid which is raised only when the sputum 
is deposited. The cup contains an antiseptic solution which destroys 
the bacilli as soon as they are deposited. The cup must be emptied and 
boiled at short intervals. 

Discuss the theory of hereditary tendencies as applied to 
tuberculosis. 

While there is no evidence that the disease is ever congenital, the 
children of tuberculous parents are usually weak and lacking in resistance. 
It is now believed that such children contract the disease from the mother, 
if she is tuberculous, or from other tuberculous members of the family. 
Association with a tuberculous individual is regarded as a stronger 
etiological factor than descent from tuberculous parents or ancestors. 

What is the lowest temperature of steam at which pus cocci 
are destroyed? 

At 240 F. the organisms are killed in a few minutes; steam at 212 F. 
kills them in about forty minutes. 

What gases are most efficient as disinfectants? 

Formaldehyd, chlorin, and ozone. 

Mention five satisfactory disinfectants and give indications 
for their use. 

Formaldehyd for disinfecting rooms. Carbolic acid, 1 to 40, for 
disinfecting clothing. Bichlorid of mercury, 1 to 1000, for the hands and 
also for clothing. Oxalic acid for the hands and for porcelain ware. 
Chlorid of lime for disinfecting urine and feces, water-closets, etc. 

Describe in detail the process of disinfection by formaldehyd 
(formalin). 

Make the room as nearly air-tight as possible by sealing all openings 
and cracks with adhesive plaster. The contents of the room, mattresses, 
pillows, clothing, books, table-drawers, etc., must be fully exposed to the 
action of the gas. Place one pound of formalin for every 1000 cu. ft. of 
air-space in a Novy generator, start the generator, and allow the room to 
remain closed for one day. 

What abnormal condition of the eyes is most common in 
school children? 

Myopia. 

What habits of school children tend to produce myopia? 

Reading small or imperfect print; reading or writing in a faulty 
position, with insufficient or improper illumination, or when fatigued. 






SCHOOL HYGIENE 283 

What diseases are incident to school life? How may these 
diseases be prevented? 

The infectious diseases, diseases due to animal parasites infesting the 
exterior of the body, curvature of the spine, myopia, nervous diseases, 
and anemia. 

The infectious and parasitic diseases may be prevented by early recog- 
nition and prompt removal of the affected pupils. For this purpose 
systematic school inspection is necessary. Curvature of the spine may be 
prevented by using properly constructed school furniture, disposed in 
such a way as to secure the best illumination, and by teaching the children 
to hold themselves properly when reading and writing. The same meas- 
ures, with the additional precaution of using text-books with clear, large 
print, will combat the development of myopia and other refractive errors. 
Plenty of out-door exercise and a substantial hot lunch in the middle of the 
day minimize the occurence of nervous diseases and anemia. 



What precautions should be taken in school=rooms to pro- 
tect the sight of scholars? 

The walls of the room should be of a neutral tint and the light should 
enter in such a way as to fall over the left shoulders of the pupils, who 
must not sit facing the windows. Blackboards must not have a glossy 
surface and must not be placed between windows. Text-books should be 
printed in large, clear type on unglazed paper. Faulty posture in reading 
or writing must be corrected immediately. If towels are supplied, chil- 
dren suffering from an inflammatory disease of the eyes must be prohibited 
from using the general supply. All defects in vision are to be reported 
to the parents, who should consult a competent oculist and have them 
corrected. 



State in a general way the maximum number of hours that 
primary pupils in the public schools should be kept at their 
tasks, and how frequently and in what manner such tasks may 
be varied and broken. 

A half hour at one given task is sufficient; after that the character 
of the mental work should be changed. At the end of an hour's mental 
application five or ten minutes should be spent in light calisthenic exercises. 
During the course of three hours' study there should be a recess of twenty 
minutes in the open air. The intermission in the middle of the day for 
lunch should be about two hours, and the afternoon session, lasting two 
hours, should be interrupted by a fifteen minutes' recess. 



What evil consequences frequently result from the excessive 
use of tobacco? 

Catarrhal inflammation of the nose, mouth, pharynx, and larynx; 
nervous affections of the heart, palpitation, intermittence, and later myo- 
carditis; digestive troubles, anorexia, gastritis; insomnia, nervous tremors, 
muscular twitching; partial or complete temporary blindness (toxic 
amblyopia). 



284 HYGIENE 

Mention some of the results of tobacco smoking in growing 
schoolboys in respect to the circulation, air=passages, vision, 
and mental application. 

Smoking depresses the circulation and causes palpitation of the heart 
on the least exertion ; it sets up a low-grade catarrhal inflammation of the 
upper air-passages, leads to chronic conjunctivitis, and impairs the powers 
of concentration and sustained mental application. 

Define the term "quarantine," mention the principal quar- 
antinable diseases, and give the rules for determining the length 
of time each should be quarantined. 

The adoption of measures to prevent the introduction of disease from 
one country or locality into another. The word originally meant isolation 
for forty days (quarante, Italian, "forty"). 

The principal quarantinable diseases are: cholera, small-pox, yellow 
fever, scarlet fever, typhus fever, plague, dengue, diphtheria, relapsing fever, 
leprosy, and cerebrospinal fever. In cases of eruptive fevers (small-pox, 
scarlet fever) isolation of the patient is continued two weeks after the cessa- 
tion of desquamation; in diphtheria, until two negative cultures have been 
obtained from the affected area; in cholera and dengue, two weeks after 
the disappearance of all symptoms. 

Give a medical and hygienic plan for the inspection of immi= 
grants who have just arrived at a seaport. 

First examine the "bill of health " and the records of all cases treated 
during the voyage, as well as the list of passengers and crew. Then 
examine the entire ship's company for transmissible disease. If a case 
of infectious disease occurred during the voyage, disinfect all freight and 
clothing that has been exposed to the infection, and detain all the persons 
who have been exposed until the period of incubation of the disease has 
passed. If cholera is suspected, examine all steerage passengers for the 
purpose of detecting and isolating " carriers. " 

What are (a) toxins and (b) antitoxins? Give the theory on 
which the prophylactic and the medicinal use of antitoxins is 
based. 

(a) Toxins are the products, more or less poisonous, elaborated by 
bacterial cells, (b) Antitoxins are specific bodies contained in the blood- 
serum which combine with and neutralize toxins; they are obtained from 
the serum of immunized animals. 

It is a well-known fact that a person or animal cannot be immediately 
reinfected with the same disease, and it has been demonstrated that if an 
animal is injected with serum obtained from another animal which has 
recovered from a specific disease, the injected animal cannot be infected 
with the same specific disease. 

Describe the manner in which antitoxin is prepared. 

A virulent culture of the specific micro-organism is injected, under 
aseptic precautions, into the cellular tissue of the selected animal, usually a 
horse. After the animal has recovered from the symptoms thus produced, 
a second, stronger injection of the specific poison is administered, and 



IMMUNITY 285 

these injections of progressively increasing virulence are continued at 
suitable intervals, until the injection ceases to be followed by any symp- 
toms of the disease. The animal is then said to be immunized. Under 
strict aseptic precautions blood is then withdrawn from the jugular vein, 
received in sterile tlasks, which are immediately stoppered and stored in 
refrigerators until separation of the clot and serum takes place. The 
serum is tested by animal inoculation to determine its antitoxic power, and, 
after the addition of a small quantity of carbolic acid, put up in glass 
tubes which are at once hermetically sealed. Each tube has marked on it 
the strength in units, either of the entire contents or that of each cubic 
centimeter, and the date after which the antitoxin loses its activity. 

What is meant by natural and by acquired immunity from 
disease? Give an example of each. 

Certain animals and human beings are insusceptible to certain diseases 
and cannot be infected with them. Dogs are not susceptible to tubercu- 
losis or cholera ; negroes are practically immune to yellow fever. 

Acquired immunity is a condition of the body in which an antitoxin 
has been developed in the blood-serum as the result of (1) a previous 
attack of the disease; (2) the injection of attenuated virus of the disease, 
as in vaccination; or (3) the injection of antitoxin obtained from an immu- 
nized animal. Persons who have had an attack of small-pox or yellow 
fever are immune to those diseases; vaccination protects the individual 
against small-pox; the injection of a prophylactic dose of diphtheria anti- 
toxin protects against the disease in the presence of the infection. 

From what diseases may immunity be acquired in the case 
of persons who have suffered from these diseases? How is 
the knowledge of this fact utilized in the prevention of certain 
diseases? 

Cholera, typhoid fever, typhus fever, pertussis, chicken-pox, mumps, 
measles, scarlet fever, small-pox, and yellow fever. Small-pox is pre- 
vented by vaccination, which produces in the individual an attenuated 
form of the infection. 



SURGERY 



CONGESTION AND INFLAMMATION 

Describe active congestion; passive congestion. State their 
points of difference. 

Active congestion is an increase in the amount of blood in the arteries of 
a part, with an increase in the velocity of the blood-stream. The part is 
reddened, not perceptibly enlarged, and the velocity of the blood-current, 
the temperature, and the functional activity of the part are increased. 

Passive congestion is an increase in the amount of blood in the veins and 
capillaries of a part, with diminished velocity of the blood-stream. The 
part is bluish, greatly swollen, and the velocity of the blood-current, the 
temperature, and the functional activity of the part are diminished. 

What is inflammation? How does inflammation extend 
and how may it terminate? 

Inflammation is the succession of changes which occur in living tissue 
when it is injured, providing the injury is not of such a degree as to destroy 
the structure and vitality of the tissues at once. The cardinal symptoms 
of inflammation are pain, heat, redness, swelling, and impaired function. 
Inflammation may extend by continuity, by contiguity, through the blood, 
or through the lymphatics. Inflammation may terminate by resolution, 
suppuration, ulceration, or gangrene. 

Give the etiology of inflammation. 

Predisposing causes are those which impair the general vigor, injure the 
blood, weaken the tissues, or impair the nutrition. Among these causes 
are shock, hemorrhage, gout, rheumatism, diabetes, B right's disease, 
alcoholism, and syphilis. 

Exciting causes are mechanical, chemical (stings of insects, ivy poisoning, 
etc.), thermal (heat and cold), and bacterial. 

What is the difference between congestion and inflammation? 

Congestion is an excess of blood in the blood-vessels of a part. The 
part is reddened, the temperature is increased, swelling is scarcely appre- 
ciable, pain is not present except that the patient may complain of a throb- 
bing sensation, and the function and nutrition of the part are increased. 
Inflammation is the result of injury (see preceding question). The part is 
reddened, the temperature is also increased, the swelling is usually con- 
siderable, and pain is present, depending upon the character of the tissue 
involved, the severity of the injury, and the reaction of the tissues. The 
function of the part is diminished, and fever is usually present. 

In what stage of inflammation is cold of value? 

It is of value in the very early stages of inflammation. Later it dimin- 

286 



SUPPURATION 287 

ishes the blood-supply to the part and, by keeping away the leukocytes, 
reduces the natural resistance. 

What is septicemia (blood-poisoning)? What causes it? 

A general bacterial infection of the entire body, usually due to strepto- 
coccus pyogenes. 

Mention the inflammatory diseases of bone. 

Periostitis, ostitis, and osteomyelitis. 

Define the terms thrombosis, phlebitis, and varix. Give 
the causes of each. 

Thrombosis. — The coagulation of blood within the blood-vessels or 
heart during life. The coagulum or clot is called a thrombus. The cause 
is some disturbance which impairs the vitality of the vessel wall or retards 
the blood stream. 

Phlebitis. — Inflammation of a vein. It may be caused by an injury 
to the coats of the vein, or by infection of the vessel wall from within or 
without. 

Varix. — Dilatation, elongation and tortuosity of a vein or veins, due to 
traumatism, obstruction of the vessels, or congenital malformation. 

What is an abscess? 

An abscess is a circumscribed collection of pus surrounded by a wall of 
lymph. 

Define acute and chronic abscess. 

An acute abscess is a circumscribed collection of pus which develops 
with all the signs and symptoms of inflammation. A chronic abscess is one 
which forms without the signs and symptoms of inflammation, and is 
usually tuberculous. 

How does a carbuncle differ from a furuncle? 

A carbuncle is a localized inflammation of the skin and subcutaneous 
tissue with necrosis, involving a much larger surface than a furuncle, and 
attended by the formation of sloughs of a considerable size. It differs 
from a boil in being much larger, flattened instead of conical, and accom- 
panied by extensive edema of the surrounding tissues. The skin gives way 
in several places, and large sloughs are discharged. The causes of car- 
buncle are certain constitutional diseases and deep infection. Furuncles 
result from infection of the gland-ducts or hair-follicles of the skin. 

What are the symptoms of septic surgical fever? 

The condition is ushered in, from thirty-six to forty-eight hours after 
an operation or injury, by chilly sensations and general discomfort. The 
temperature rises sharply and is characterized by evening exacerbations 
and morning remissions, reaching its greatest height about the third or 
fourth day, when suppuration sets in. The temperature, which may 
reach 104 F. or more, begins to drop as soon as free exit for the pus is 
established, and becomes normal in a few days. The patient exhibits 
the general phenomena of fever: thirst, anorexia, nausea, dry and coated 



288 SURGERY 

tongue, constipation, headache, and pain in the back and legs. The urine 
is scanty and high colored. Examination of the blood usually shows a 
decided leukocytosis. The wound is painful, tender, swollen, and later 
contains pus. 

Define septicemia and give its causes. 

A septic intoxication caused by the absorption of the products of putre- 
faction or by the entrance of bacteria into the blood. Symptoms: Irregu- 
lar temperature, ranging from ioo° to 105 F.; weak and very rapid pulse; 
frequent chills; severe headache; nausea; often vomiting and diarrhea. 

What is the differential diagnosis between septicemia and 
pyemia? 

Pyemia is septicemia plus metastatic abscesses. The diagnosis of 
pyemia is based on the presence of symptoms of abscesses. 

Describe suppurative cellulitis. 

An infection of the subcutaneous tissue, characterized by pain, ten- 
derness, redness, fluctuation, and enlargement of the lymphatic glands. 
The treatment includes incision, irrigation, and drainage of the infected 
area. 

Describe an ulcer and a fistula. 

An ulcer is a loss of substance due to molecular death of a superficial 
structure. A fistula is an abnormal communication between the surface 
and an internal part of the body, or between two natural cavities or canals. 

Describe traumatic ulcer of the tongue. 

There is usually a history of injury, and the lesion may be found on 
any portion of the tongue. The shape is irregular, not characteristic; 
there is no tendency to recurrence after healing; and there is no associa- 
tion with other disease of the mouth. 



How are wounds classified? 

Incised, lacerated, contused, punctured, poisoned, and gunshot. 
They may also be divided into septic and aseptic. Wounds in the vicinity 
of great serous cavities are divided into penetrating and non-penetrating. 

What are the sources of wound infection? 

The foreign body making the wound; the skin of the patient; the 
hands of the surgeon; solutions, instruments, ligatures, sutures, dressings, 
and, at times, aerial infection. 

Describe the aseptic and the antiseptic methods of treatment 
of wounds. 

In the aseptic method heat, chemical germicides, or both are used to 
cleanse the instruments, the field of operation, and the hands of the sur- 
geon, the surface being freed from the chemical germicide by washing 
with boiled water or saline solution. After the incision has been made, 
no germicide is used. 

In the antiseptic method the preparations for the operation are the 



HEMORRHAGE 289 

same as in the aseptic method, but during the operation an antiseptic 
solution, usually bichlorid of mercury, 1:2000, is used instead of sterile 
water or saline solution, and the sponges, pads, and dressings of the 
wound are impregnated with the antiseptic solution. 

State the indications for draining a wound. Give a method 
of securing such drainage. 

Drainage is indicated when a wound cannot be closed without leaving 
a cavity for the accumulation of blood, and when infection is present. 

Drainage is secured by introducing a fenestrated rubber tube into 
the wound and suturing it fast to the edges. 

Describe the following forms of sutures: interrupted, button, 
continued, buried, and secondary. 

The interrupted suture consists of a number of single stitches, each one 
being independent of its neighbor. The button suture consists in passing 
the threaded needle through an eye of a button, then through the edges 
of the wound and a button on the other side, back through the other eye 
of the last button, then through both sides of the wound the reverse way, 
and, finally, through the remaining eye of the first button; tie both ends 
together over the button. In a continued suture the suture traverses the 
wound continuously in the same direction, being tied only at the beginning 
and at the end. A buried suture is one completely covered by, and not 
involving, the skin. Secondary sutures are those which are introduced at 
some time subsequent to an operation — usually two or three days later. 

Mention the materials employed for sutures and for ligatures. 

For sutures: silkworm-gut, catgut, silk, horsehair, linen thread, silver 
wire. For ligatures: silk, catgut, kangaroo tendon. 

HEMORRHAGE 

What are methods of controlling hemorrhage? 

Exposure to air, cold or hot water, elevation, direct pressure, styptics, 
cauterization, acupressure, suture, torsion, and ligation. 

Describe intermediate and secondary hemorrhage, giving 
both preventive and curative treatment of each. 

By intermediate hemorrhage is meant a hemorrhage recurring within 
forty-eight hours of an operation or accident. Preventive Treatment. — 
The proper method of tying the ligatures, which should include the 
artery alone, and not the surrounding tissues. All bleeding-points should 
be carefully and completely controlled at the time of injury, and stimu- 
lants should not be injudiciously employed. Curative Treatment. — Eleva- 
tion and pressure. If these measures are not successful, the wound 
should be re-opened, irrigated with hot salt solution, and all bleeding 
points tied. If ligatures cannot be applied, the actual cautery may be 
used or the wound packed with antiseptic gauze. 

By secondary hemorrhage is meant any hemorrhage occurring in a 
wound after the lapse of forty-eight hours. Preventive Treatment. — 
Thorough asepsis, the proper application of ligatures to all bleeding points, 
19 



290 



SURGERY 



and the avoidance of the injudicious use of stimulants. Curative Treat- 
ment. — This will depend upon whether the hemorrhage comes from the 
end of a divided artery or from an artery which has been ligated in its 
continuity. If the hemorrhage comes from the end of an artery, elevate 
and apply pressure. If this does not stop the bleeding, open the wound 
and ligate; if possible, pack with gauze or resort to the cautery. 

How would you treat persistent bleeding after lancing the 
gums of a child? 

Local application of adrenalin chlorid and pressure. If this is not 
satisfactory, tannic acid and pressure may be tried. If the above does 
not stop the bleeding, the administration of small doses of calcium 
chlorid, or injection of blood-serum may be tried. 

LIGATIONS 

What are the steps in the ligation of arteries? 

Incision — dividing the skin and superficial fascia at an angle of about 
five degrees to the course of the artery; division of the deep fascia; recog- 
nition of the muscular or bony guide and the location of the vessel by its 
pulsation; opening of the sheath; passage of the aneurysm needle; tying of 
the ligature and closure of the wound. 

Describe the operation for ligating the facial artery. 

An incision is made dividing the skin, superfical fascia and platysma 
immediately below the mandible, at the anterior margin of the masseter 
muscle. The vessels at this point can be distinctly felt and seen. A 
ligature is passed around the vessel and tied; skin and fascia are sutured. 

What are the indications for ligature of the lingual artery? 
Give the steps of the operation, omitting aseptic details. 

The lingual artery is most frequently tied as a preliminary procedure 
to removal of the tongue. Other indications for its ligation are to control 
hemorrhage from the artery or its branches, to check the growth of ad- 
vanced carcinoma of the tongue, and in certain cases of macroglossia. 

Operation. — The patient should be on his back, his shoulders raised, 
and the head extended and turned to the opposite side. Starting just 
below the symphysis of the jaw, an incision is made which passes down- 
ward and outward to the greater cornua of the hyoid bone, and then up- 
ward to the angle of the jaw. This incision divides the skin, both layers 
of the superficial fascia with the inclosed platysma, and exposes a portion 
of the submaxillary gland. The deep fascia covering the gland is now 
incised, and the gland loosened and held up by a retractor. Lesser's 
triangle, formed by the two bellies of the digastric muscle below and the 
hypoglossal nerve above, is now exposed. The floor of this triangle is 
formed by the hyoglossus muscle. The stylohyoid and the tendon of 
the digastric are drawn downward, the lingual vein and the hypoglossal 
nerve upward, and an incision is carefully made through the hyoglossus 
muscle just above the hyoid bone. An aneurysm needle armed with a 
ligature is now passed about the artery, the ligature tied, and the external 



TUMORS 291 

wound sutured. The artery may also he ligated before it passes beneath 
the hyoglossus muscle. 

How may a quart of normal salt solution be prepared at the 
patient's home? 

By dissolving two teaspoonfuls of salt in a quart of boiled water. The 
salt may be sterilized by baking it in the oven. 

What is shock, and how should it be treated? 

Shock is a sudden depression of the vital powers arising from an injury 
or a profound emotion acting on the nerve-centers and inducing exhaus- 
tion or inhibition of the vasomotor mechanism. Treatment. — In ordinary 
shock raise the feet and lower the head, unless this position causes cyanosis. 
Wrap the patient in hot blankets and surround him with hot bottles. 
If shock develop during an operation, the operation must be hurried or 
even stopped, and proper treatment must be instituted at once. The 
general opinion is against operating during shock, excepting when death 
without instant operation is inevitable. If hemorrhage is the cause, 
the bleeding must be arrested. 

How would you arrest epistaxis? 

Apply cold or hot water, pressure, or a solution of adrenalin or melted 
gelatin. If these methods are inefficient, cauterize the bleeding point, 
if possible, with silver or chromic acid. When this fails, the anterior 
nares should be packed with a strip of sterile gauze, the initial extremity 
of which is carried well back toward the nasopharynx. In rare cases it 
may be necessary to plug the posterior nares with gauze by means of 
Bellocq's cannula or a soft-rubber catheter. 

How would you treat excessive hemorrhage after tooth 
extraction? 

Pack the root with adrenalin gauze, cover with a larger pad, and firmly 
bandage the lower against the upper jaw. This will usually stop the 
hemorrhage, providing it is not due to hemophilia, in which case 
blood-serum should be injected subcutaneously, or transfusion of blood 
performed. 

TUMORS 

What is a tumor? 

A tumor is a pathologic new-growth which tends to persist indepen- 
dently of the structures in which it lies, and which performs no physiologic 
function and has no known cause. 

Name the different varieties of malignant tumors. 

Sarcoma (round, spindle, giant-cell, melanotic, alveolar), lymphosar- 
coma, endothelioma, carcinoma (epithelioma; scirrhous, encephaloid, 
melanotic, and colloid cancer). 

Name the different varieties of benign tumors. 

Lipoma, fibroma, chondroma, osteoma, myxoma, angioma, lymph- 
angioma, myoma, neuroma, adenoma, and papilloma. 



292 SURGERY 

Mention the general characteristics of a benign tumor, as 
distinguished from a malignant tumor. 

Benign tumors, in contradistinction to malignant tumors, are usually 
encapsulated, grow slowly, do not infiltrate, are not painful, do not give 
metastasis, do not recur after removal, produce no cachexia. 

Through what channels is carcinoma disseminated? 

Through the lymphatic and blood-channels. 

What is an epulis? 

This is a term which is applied to various tumors of the gums. They 
do not originate in the gums, but from the periosteum of the alveolar 
process and sockets of the teeth. Two forms are usually described: 
simple or fibrous, and malignant or myeloid epulis. 

Give the diagnosis, clinical appearance and treatment of 
myeloid sarcoma. 

Giant-cell, myeloid or medullary sarcoma is characterized by the pres- 
ence of numerous very large cells, with many nuclei, looking exactly like 
the myeloplax of bone-marrow. The cut surface of such a growth is 
maroon colored. It arises usually from bone, especially from the interior 
of a long bone, hence is often called osteosarcoma. 

Myeloid sarcoma is invariably single. It may arise from other struc- 
tures than bone. It is the least malignant form of sarcoma. 

Treatment consists in complete excision of the growth, but not the 
entire bone. 

When is operative interference advisable in the treatment 
of malignant tumors? 

Operative interference is advisable when the growth can be thoroughly 
removed, when the operation will diminish the pain or make the patient 
more comfortable, and when it will lengthen life. 

What general principles govern the diagnosis of a tumor? 

Age, sex, hereditary influence, previous history, the location, shape, 
size, consistency, and rapidity of the growth of the tumor, movability of 
the tumor, whether it has given rise to metastases, whether the neighboring 
glands are involved, and the presence or absence of cachexia. 

What is an adenoma? 

Adenomata are tumors corresponding in structure to normal epithelial 
glands. They may contain acini and ducts, like racemose glands, or 
tubes, like tubular glands. Unlike normal glands, these tumors have no 
secretory ducts and no physiologic function. 

What are angiomata? 

An angioma is a tumor composed largely of dilated blood-vessels. 
Some of the so-called angiomata are not genuine new-growths, but are due 
to dilatation and elongation of blood-vessels. 



TUMORS 293 

Describe a chondroma. Where are such growths most 
commonly found? 

Chondromata are tumors formed either of hyaline cartilage or of fibro- 
cartilage, or of both. They may be single or multiple, and are most com- 
monly seen in the young. 

Seats of Predilection. — The bones, especially on or in the phalanges, 
the lower epiphyseal region of the femur, the upper ends of the tibia, fibula, 
and humerus, the scapula, the ilium, the jaws, especially the upper, the 
salivary glands (notably the parotid), and the testicle. 

What are gliomata and where are they found? 

A glioma consists of cells containing round or oval nuclei with very 
little protoplasm, and fine protoplasmic extensions which interlace and 
form an intercellular reticulum. These tumors develop from neuroglia, 
and more often from the white substance than from the gray. They are 
usually single and arise in the brain, rarely in the cord, and very rarely 
in the cranial nerves. 

Describe dermoid cysts. In what situations are they most 
commonly found? 

A dermoid is a heterotopic cyst, the w r all of which is composed of con- 
nective tissue lined with epithelium. The cysts contain material formed 
by the proliferation of the epithelium, and frequently hair, teeth, or even 
bone. Dermoid cysts are most commonly found in the ovary and in re- 
gions where, during bodily development, the blastodermic layers come in 
contact; for instance, in the neck, the eyelids, the orbital angles, the region 
of the coccyx, the root of the nose, and the floor of the mouth. 

Define odontoma. Give the classification, clinical appear= 
ance, and the treatment of odontoma. 

Odontomata are tumors composed of tooth-tissue. They spring 
from the gums of teeth or from developing teeth. Sutton divides them 
into (1) those springing from the follicle; (2) those springing from the pa- 
pilla; and (3) those springing from the whole germ. 

Epithelial odontomata are multilocular cystic tumors arising from the 
follicle. They occur usually in the lower jaw, dilate the bone, possess a 
capsule and are made up of masses of cysts, filled with brown fluid. These 
cysts are seen most frequently in subjects under twenty years of age. 
Follicular odontomata or dentigerous cysts oftenest spring from the folli- 
cles of the permanent molars. In a dentigerous cyst there exists an ex- 
panded follicle which distends the bone, the follicle being filled with 
thick fluid and containing a portion of a tooth. A fibrous odontome 
is due to thickening of the tooth-sac which prevents eruption of the tooth. 
Tumors of this type are usually multiple and are apt to occur in rickety 
children. A cementome is due to enlargement and ossification of the 
capsule, the developing tooth being encased in cement. A compound 
follicular odontome is due to ossification of portions only of an enlarged 
and thickened capsule, and the tumor contains bits of cementum, portions 
of dentin or small misshapen teeth. 

A radicular odontome springs from the papilla developing after the 



294 SURGERY 

crown of the tooth is complete and while the roots are forming; hence, 
it contains dentin and cement, but no enamel. 

Composite odontomes consist of irregular shapeless masses of dentin, 
cement, and enamel. 

All the above forms present themselves as hard tumors associated 
with teeth and in an area where teeth have not erupted. Occasionally 
an odontome simulates necrosis; it is then surrounded by pus and a sinus 
forms. In all tumors of the jaw Rontgenography will assist in the 
diagnosis. 

Treatment. — Excise a portion of the wall, remove the implicated 
tooth, curet the cavity, and pack with gauze. This is usually sufficient, 
but in a few cases the growth must be entirely removed. 



DISEASES OF BONES AND JOINTS 

Define synovitis. Give the symptoms and treatment. 

Synovitis is an imflammation of the synovial lining of a joint. The 
symptoms are pain, tenderness, swelling, rigidity of the surrounding 
muscles, and limitation of motion of the joint. 

Varieties. — Rheumatic, syphilitic, tuberculous, and suppurative. 

Treatment. — This depends upon the variety. If rheumatic, antirheu- 
matic treatment; if syphilitic, antisyphilitic treatment; if tuberculous, 
rest, fresh air, and feeding; if suppurative, incision, irrigation, and drain- 
age. In all varieties, passive motion and massage should be started very 
early. 

What are the varieties of ankylosis? 

Ankylosis may be complete (bony) or incomplete (fibrous); it may 
arise from contractures in the joint (true or intra-articular) or from 
contractures in the structures external to the joint (false or extra-articular) . 

How can the danger of ankylosis be averted after injury to 
a joint? 

By rest and the early employment of massage and passive motion 

Describe the surgical methods for the re=establishment of 
joint function in confirmed ankylosis. 

Chiseling out the bones and interposing a strip of fascia or muscle; 
if this fails, resection of the joint. 

Give the cause and treatment of noisy movements of the 
maxillary articulation. 

Dislocation, causing relaxation of the ligaments and surrounding 
structures; displacement of the interarticular cartilage; separation of a 
portion of the lining of a joint or old synovitis. 

Treatment. — Immobilize the joint as far as possible; electricity; or the 
joint may be injected with formalin. Lastly, it may be necessary to open 
the joint and remove the body. 






DISEASES OF BONES AND JOINTS 295 

What are the conditions which render excision of the lower 
jaw advisable? 

Malignant tumors of the mandible; malignant tumors in the adjacent 
tissues involving the bone secondarily. 

Give the etiology, symptoms and treatment of acute periostitis 
of the inferior maxillary bone. 

Etiology. — Caries of teeth, acute contagious diseases, and traumatism. 

Symptoms. — Acute throbbing pain, tenderness, very slight swelling; 
if suppuration is present, redness and enlargement of the glands. 

Treatment. — Hot applications, removal of the cause. If suppuration 
is present, incise and drain, if possible, through the mouth. 

State why early operative interference in necrosis of the 
jaw is harmful. 

The disease usually limits itself and any interference beyond removing 
the source of irritation will infect a larger area. Operation causes a 
greater loss of tissue than results if nature is permitted to effect separation 
and extrusion of the necrotic portion. 

State the cause of arrest of development in the maxillary 
bones. 

Ankylosis of the temporomaxillary articulation; mouth breathing; 
premature extraction of the deciduous or permanent teeth. 

What is a sequestrum? 

The dead portion of bone which separates from the healthy bone in 
necrosis. The sequestrum may be spontaneously discharged or become 
encapsulated. 

What articular changes take place in dislocation? What 
are the general principles governing the treatment of dislocation? 

Laceration of the ligaments and the capsule of the joint, and a change 
in the mutual relations of the articular ends of the bones. If the dislo- 
cation remains unreduced, the cavity of the joint becomes filled with 
granulation tissue and the displaced and lacerated tissues become con- 
densed about the head of the dislocated bone. Any irregularities of the 
dislocated bone become rounded off, and the surrounding tissues form 
a false joint. 

Principles of Treatment. — Relaxation of the muscles about the joint; 
reduction of the dislocation by causing the dislocated bone to enter the 
capsule through the same rent which it made upon leaving it (by manipu- 
lation, extension, and counterextension) ; fixation of the parts after reduc- 
tion, followed by massage, and active and passive motion after about ten 
days. 

Mention obstacles to reduction of dislocations. 

Muscular resistance, anatomic peculiarities of the joint, the interposi- 
tion of a portion of the capsular ligament or a muscle, fracture of the bone 
involved, and the presence of adhesions (old dislocations). 



296 SURGERY 

Mention the accidents that are liable to occur during the 
reduction of a dislocation. 

Fracture of the bone, rupture of the vessels, and injuries to the nerves. 

Describe a method of reduction of a dislocation of the 
inferior maxillary bone. 

The patient is seated; the surgeon stands in front of the patient and 
presses down upon the molar teeth with his two thumbs, which are 
guarded by a towel. This pressure is continued in a downward and back- 
ward direct ion until the condyle clears the eminentia articularis; then the 
chin is to be raised by the fingers, and the condyle snaps in place. The 
jaw should be kept at rest for four or five days with a Barton bandage. 

Give a differential diagnosis of suppuration of the maxillary 
sinus and tumor of the maxillary sinus. 

Suppuration Tumor 
History of alveolar abscess or rhinitis History of gradual onset. Gradual de- 
of rapid onset. Very little deformity ; formity, with projection into nose 
moderate fever. Discharge of pus; and orbit. No fever; no pus; mod- 
acute throbbing pain, with edema. erate pain; no edema. 
X-ray shows moderate blurring over X-ray shows enlarged and thickened 
antral region; exploratory puncture mass in antral region; puncture of 
through lateral nasal wall liberates lateral nasal wall negative, 
pus. 

Give the diagnosis and treatment of acute abscess of the 
antrum. 

As stated elsewhere, it is due to infected roots, alveolar abscess, or 
inflammation of the nose. 

The symptoms are fever, rapid pulse, throbbing pain over the antrum 
and in the roof of the mouth ; tenderness in the roof of the mouth and over 
the superior maxillary bone. Frequently there is a slight discharge from 
the nose. A test with a light in the mouth will show a blurring on the 
affected side. If in doubt, puncture the lateral wall of the nasal fossa and 
pus will be obtained. 

Treatment. — If due to root disease or alveolar abscess, extract the 
tooth or teeth, and open the antrum through the alveolar margin. If it is 
due to disease of the nose, open through the lateral nasal wall. In either 
case, irrigate the cavity daily. 

State why an alveolar abscess may cause inflammation of 
the maxillary sinus. 

Normally the roots of the bicuspids and first molar project into the 
base of the antrum. Any inflammation of these adjoining teeth may 
directly contaminate the antrum. 

What diseases attack the antrum maxilla? (Highmore)? 

Hydrops, empyema, tuberculosis, benign tumors (chondroma, fibroma, 
osteoma), and malignant tumors (sarcoma and carcinoma). 

Mention three tumors of the antrum. 

Osteoma, sarcoma, and carcinoma. If they are not too large and 
have not progressed too far, they should be removed. 



PHOSPHORUS NECROSIS 297 

Give the etiology, symptoms and treatment of abscess of 
the hard palate. 

Etiology. — Traumatism with a dental instrument; infected root canals 
following typhoid fever. 

Symptoms. — Redness, pain, tenderness, swelling, fluctuation. 
Treatment. — Open and drain. Remove the cause if still present. 

Give the etiology, symptoms, and treatment of arsenical 
necrosis of the alveolar process. 

Usually due to imperfect application of arsenic to root canals. 

Symptoms. — Pain, tenderness, infection; a small sinus develops around 
the infected tooth. 

Treatment. — Extract the infected tooth and treat the wound locally; 
later if necessary, scrape with curet. 

Describe the appearance of a syphilitic perforation of the 
hard palate. 

An irregular perforation situated on the posterior third, with grayish 
sloughing edges. Portions of the bone are usually exposed. 

Differentiate an acquired cleft palate and a congenital cleft 
palate. 

In the congenital form there is a history of cleft palate being present 
at birth. Acquired cleft palate is one that appears after birth, and is 
usually due to syphilis. 

Describe the healing of fractured bone. 

When a bone is broken a blood clot quickly forms in the medullary 
cavity between the broken ends and under and outside of the periosteum 
Leukocytes invade and destroy the clot. The cells outside of the perios- 
teum, those of the periosteum, and of the medullary tissue, particularly the 
endothelial elements, undergo active proliferation, resulting in the forma- 
tion of cells which are practically fibroblasts. Similarly the osteoblasts in 
the medullary tissue, and perhaps in the deeper layers of the periosteum 
multiply and are distributed through the mass of fibroblasts. The osteo- 
blasts may form bone directly or after passing through the cartilaginous 
stage. The point is not settled, but it is well to remember that in myositis 
ossificans muscle is converted into bone; hence it is probable that fibro- 
blasts, which are formed from periosteum and medullary tissue, are much 
more prone to undergo such a metamorphosis. This newly formed tissue 
which unites the broken ends is known as callus. During the further 
regeneration the ends of the bone soften and are partially absorbed by 
the osteoclasts, which ultimately also absorb the excess of callus (Da 
Costa). 

Give the etiology and treatment of phosphorus necrosis. 

Usually occurs in workers in phosphorus, more particularly match- 
makers. 

It can be prevented by careful attention to the teeth, washing hands 
before eating, and providing proper ventilation and removal of the phos- 
phorus fumes in the workroom. 



298 SURGERY 

Treatment. — Removal of all diseased teeth and roots; alkaline mouth 
wash; removal of necrotic fragments as they become loose. Systematic 
treatment with tonics and fresh air. 

How are dislocations distinguished from fractures? 

Dislocations are characterized by more or less immobility and absence 
of crepitus. The deformity does not usually recur after reduction. The 
end of the bone is felt in an abnormal position and rotates with the rest of 
the bone. Fractures are characterized by preternatural mobility and the 
presence of crepitus; the deformity usually recurs after reduction. 

Differentiate between fracture and dislocation of the mandible. 

Fracture Dislocation 

Cause: Injury. Cause: Yawning. 

Point of chin directed toward injured Point of chin directed toward sound 

side. side. 

Crepitus. Crepitus absent. 

Alignment of teeth frequently disturbed. No changes in alignment. 

Preternatural movement of the bony Not present. 

fragments. 

Define a fracture. Give the causes, symptoms, and varieties 
of fracture. 

A fracture is a sudden solution of the continuity of a bone. 

Predisposing Causes. — Advanced age, male sex, and diseased con- 
ditions of the bone. 

Exciting Causes. — Direct violence, indirect violence, and muscular 
action. 

Symptoms. — Deformity from displacement, partial or complete loss of 
function, preternatural mobility, crepitus, and local signs of trauma. 

What is a compound fracture ? (b) An adenoid ? 

A compound fracture is a solution in the continuity of a bone communi- 
cating with the air. (b) An adenoid is an over-growth of lymphoid 
tissue situated in the nasopharynx. 

What conditions are necessary to obtain bony union after 
fracture? 

Perfect apposition of the fragments, maintained by suitable mechan- 
ical appliance. Removal or destruction (by active friction) of any fibrous 
or other extraneous tissue interposed between the fragments. Correction 
of any constitutional disorder (syphilis, lead poisoning, etc.) that may 
interfere with the general nutrition. 

Give the treatment of fracture of the superior maxilla. 
State the complications that may arise. 

Set the fracture and retain it in place with an interdental plate. After 
each feeding, which should be liquid, see that the mouth is carefully 
cleansed with an alkaline mouth wash. If the teeth are missing, hold the 
fragments in place with a chin-cup, suitably padded, and a Barton 
bandage. 

Complications. — Hemorrhage; suppuration of the antrum; necrosis, 
with extrusion of sequestra; facial cellulitis. 



FRACTURES 299 

Give varieties of fracture of the inferior maxilla. 

Through the body of the bone in the neighborhood of the mental 
foramen, at the angle or within the vertical ramus, through the neck of 
the condyle, and at the base of the coronoid process. The fracture 
may be simple or compound. 

How, and in what part of the inferior maxillary bone is 
fracture most liable to occur? What is the treatment? 

The cause is usually direct violence, but indirect violence (lateral 
pressure) may fracture the body anteriorly. The most frequent seat 
of fracture is near the canine tooth. 

Treatment. — If the fracture is anterior, and the teeth are securely in 
place, an interdental splint will be sufficient; if the teeth are in place and the 
fracture is posterior to the second molar, an intermaxillary splint should 
be applied, after careful reduction. Some authorities use the Hammond 
splint for anterior fractures ; others use the Angle appliance. If the patient 
is without teeth, a chin-cup, lightly padded, should be applied and held in 
place by means of a Barton bandage. The patient should receive liquid 
food and the mouth should be washed out systematically. 

Give the diagnosis and treatment of fracture of the inferior 
maxillary. 

Symptoms. — Pain, marked tenderness, abnormal mobility; irregular 
alignment of the teeth (if present), and deformity. 

Treatment. — Reduction; the application of an interdental, inter- 
maxillary, or possibly a Hammond splint. If there are no teeth, a chin- 
cup and Barton bandage should be applied. Any deformity that may 
exist can be overcome in the formation of the lower denture. 

Give briefly your method and procedure in the treatment of 
a compound fracture of the inferior maxilla. 

The external wound should be kept as clean as possible; the fracture 
held in place by means of an interdental, or if necessary, an intermaxillary 
splint. 

Mention the causes of delayed union of a fracture and give 
the treatment. 

The constitutional causes are syphilis, rickets, scurvy, osteomalacia 
general debility, and pregnancy. The local causes are faulty apposition, 
mobility, muscle or aponeurosis between the fragments, defective blood- 
supply, defective innervation, and infection. 

Treatment. — Remove any local cause and treat the constitutional 
disease. Change of air, tonics, regulation of the diet, and the administra- 
tion of phosphorus are beneficial. 

Give the treatment of non=union in fracture of the lower 
jaw. 

The ends of the fragments should be roughly rubbed together, so as to 
destroy any intervening substances. Perfect alignment must be secured 
and maintained by means of an interdental or intermaxillary splint. If 
the teeth are missing, the fractured ends must be united with a plate. 



300 SURGERY 

Any constitutional disease that may be present, such as syphilis or 
lead-poisoning, must receive appropriate treatment. 

Describe the Hammond wire splint and state in what kind 
of fractures it can be successfully used. 

It consists of a firm wire which surrounds the entire series of teeth. 
Between the individual teeth the wire collars are connected by short cross- 
wires. The contrivance is advocated for fracture of the mandible by 
some surgeons, who contend that by its use the fragments are gradually 
forced into perfect apposition. 

What symptoms follow division of the facial nerve outside 
of the skull? 

Paralysis of the muscles of expression on the same side of the face 
without implication of the palate or uvula. The paralyzed side of the face 
is immobile, devoid of expression, and the natural folds and wrinkles are 
obscured. The eyelids cannot be completely closed, the eyeball rolling 
upward and outward when forcible closure is attempted. Epiphora is 
present from the drooping of the lower lid. The lips cannot be firmly 
closed, and whistling is impossible. Attempts to move the facial muscles 
cause the mouth to be drawn toward the non-paralyzed side. Owing to the 
paralysis of the buccinator, food collects between the teeth and th cheek. 

Differentiate between neuritis and neuralgia. 

Neuritis is an inflammation of a nerve. Neuralgia is a spasmodic 
pain occurring along the distribution of a nerve. 

Neuritis Neuralgia 

Continuous pain, tenderness along the Pain paroxysmal, 

nerve. Tenderness absent. 
Paresthesia "j 

wasting J 
Herpes not present. Sometimes accompanied by herpes. 



In trifacial neuralgia, caused by infectious diseases, malaria, 
or influenza, what division of the nerve is usually involved? 

The first or ophthalmic division. 

Describe the operation for exposure of the inferior dental 
nerve. 

This nerve may be exposed at the mental foramen by incising the 
mucous membrane immediately below the lower canine tooth. The 
usual operation consists in an incision parallel to the lower margin of the 
angle of the jaw, freeing the masseteric attachment, and trephining the 
interior maxillary bone about one inch above the angle. The nerve is 
exposed as it enters the inferior dental foramen. 

Describe tic douloureux, and give the treatment. 

A periodic neuralgia of the fifth nerve, characterized by very severe 
paroxysms of pain occurring in the distribution of one or more branches. 
The tender points correspond with the exits of the branches upon the face, 






STOMATITIS 301 

the supra-orbital, infra-orbital, and mental foramina. The paroxysms 
may occur only at long intervals or almost continuously. 

Treatment. — Regulation of the habits; correction of any dental disease, 
etc. Deep injection of alcohol into the branches as they emerge from the 
skull, which may be repeated. Finally, removal of Gasserian ganglion 
may be necessary. 

Name three congenital deformities of the oral tissues, and 
briefly outline the surgical treatment of each. 

Macroglossia, hare-lip, and cleft-palate. 

Macroglossia is an enlargement of the tongue and is usually congenital. 
The best treatment consists in removing a V-shaped piece of the tongue. 

Hare-lip. — Trim edges of cleft neatly and unite with sutures, then 
apply an adhesive plaster dressing to relieve tension on sutures. 

Cleft-palate. — Brophy's plates or Hammond's clamps are used to 
approximate the maxillary processes. After the edges of the cleft have 
been trimmed, the periosteum and the buccal mucous membrane are 
elevated from the processes and sutured together. Lateral slits along the 
alveolar margin may be required in order to bring the edges together. 

Name two varieties of cyst of the tongue. Give the treatment 
of one. 

Dermoid Cyst; Retention Cyst. — Retention cyst is due to occlusion of a 
gland duct. In every case excision is the rational treatment. 

Define stomatitis. Name the varieties and give the treat= 
ment of one variety. 

Stomatitis is an inflammation of the mucous membrane of the mouth. 

Varieties. — Simple acute, or catarrhal; aphthous; mycotic (thrush); 
ulcerative; gangrenous (noma); mercurial; and syphilitic. 

Syphilitic Stomatitis. — Antisyphilitic treatment internally (mercury and 
potassium iodid), and the frequent use of a 10 per cent, solution of potas- 
sium chlorate locally 

What is thrush? Give its cause and describe the treatment. 

Thrush is a form of stomatitis produced by the thrush fungus (saccharo- 
myces albicans). The fungus develops on the surface of the mucous 
membrane in the form of small, white flakes, resembling curds of milk, 
for which they are sometimes mistaken. They can be readily scraped off, 
leaving an intact mucosa or a slightly ulcerated surface. The growth 
begins on the tongue and buccal mucous membrane, and rapidly spreads to 
the palate, fauces and uvula. The disease is attended by a variable degree 
of catarrhal stomatitis, which is responsible for the symptoms — redness of 
the mucous membrane and the characteristic deposits, pain and discom- 
fort, evidenced by fretf ulness and a disinclination to nurse. (The disease 
occurs most commonly in infants). 

Cause. — Lack of cleanliness in caring for the baby's mouth, the nipple, 
and other articles introduced into the mouth. The thrush fungus is pres- 
ent in the air, and the disease is favored by lowered resistance, feeble 
motility, a neglected simple stomatitis, etc. The direct cause is the im- 
plantation of the specific fungus on a surface denuded of epithelium. 

Treatment. — Thrush is more easily prevented than cured. Thorough 



302 SURGERY 

cleansing of the mouth with a 2 per cent, solution of borax or bicarbonate 
of soda in glycerin and water, before and after feeding, with care to avoid 
further abrasion of the mucous membrane. Constitutional treatment — 
fresh air, tonics, etc. — must not be neglected. Thrush is contagious. 

Give the etiology, clinical appearance, and treatment of 
spongy gums. 

Etiology. — Infectious diseases; lack of cleanliness; calcareous deposits 
around the teeth. 

Clinical Appearance. — The gums are swollen and reddish gray in color, 
of soft consistency, and prone to bleed upon slight irritation. 

Treatment. — Removal of tartar and the systematic use of a soft tooth 
brush, with an astringent mouth wash. Fresh air and a strengthening diet 
are important. 

Give the etiology, clinical appearance, and treatment of 
acute ranula. 

Ranula is a retention cyst due to occlusion of the duct of the submaxil- 
lary or sublingual gland. When first formed, a ranula contains saliva, 
which after a time undergoes a change and resembles mucus in appear- 
ance. 

The tumor is covered by mucous membrane, spherical in shape, and 
situated between the tongue and the alveolar margin on one side of the 
frenum. 

The treatment consists in complete excision. 

What is leukoplakia? Give diagnosis and treatment. 

A disorder of the tongue consisting in asymmetrical patches of various 
shapes, whitish, or often pearly white in color, smooth, and without any 
tendency to ulcerate. The intensity of the opaque white color depends 
upon the thickness of the epidermis. The patches may extend and be- 
come slightly papillomatous. There are instances in which epithelioma 
has developed from them. The condition is met with most commonly 
in heavy smokers, and is sometimes known as the smoker's tongue. 

While somewhat similar patches develop in syphilitic persons, true 
syphilitic glossitis rarely presents the same opaque white, smooth ap- 
pearance. Syphilitic glossitis usually affects the edges and the tip of the 
tongue and disappears under specific treatment. 

Treatment. — True leukoplakia is a very obstinate affection, and as a 
rule, resists all forms of treatment. All irritants, such as smoking, should 
be avoided. The application of a 1 per cent, chromic acid solution has 
been advised. The patches should be carefully watched and, on the first 
suggestion of becoming papillomatous, the affected area should be ex- 
cised. 

Give the treatment for wounds of the tongue. 

If the wounds are small and not bleeding, let them alone, and order 
an alkaline mouth- wash. If the wounds are of sufficient size to suture, or 
if they are bleeding, they should be sutured with silk sutures, and an 
alkaline mouth-wash ordered. 



EXCISION OF THI. TONGUE 303 

State the predisposing causes of lingual carcinoma. 

Middle age, past forty. Any irritation, as from a jagged tooth, pipe, 
or cigar, or a badly fitting dental appliance. 

What diseases of the tongue may be mistaken for carci- 
noma? 

Chronic glossitis, traumatic and tuberculous ulcers, sarcoma, leuko- 
plakia, and primary, secondary and tertiary syphilis. 

Give a differential diagnosis of traumatic ulcer and epithe= 
lioma of the tongue. 

Traumatic ulcer may be situated anywhere, but is usually on the side 
of the tongue. The edges are not markedly indurated, and the glands 
beneath the jaw are usually not enlarged. It may occur at any age. 

Epithelioma occurs in persons past middle life. It has a markedly 
indurated base, irregular surface, abundant discharge, and is usually 
associated with enlargement of the submental and submaxillary glands. 

Give the palliative treatment of malignant tumors of the 
mouth. 

The mouth should be cleansed frequently with an alkaline mouth 
wash, especially after each meal. Constitutionally, morphin may be 
administered if the pain is very severe. X-ray treatment should be given 
systematically by one skilled in its use. 

Give an operation for excision of the tongue for carcinoma. 

Kocher's Operation. — The patient is placed in the Trendelenburg 
sloping position, with complete anesthesia, and without a preliminary 
tracheotomy. A silk suture is passed through the tip of the tongue as a 
retractor. An incision is made in the middle line through the lower lip 
down to the bone, and extending as far as the hyoid bone, forceps being ap- 
plied to the divided vessels in the lips. The jaw is then sawn through just 
outside of the incisor teeth. In order to preserve the geniohyoides and 
geniohyoglossi on both sides, holes are first bored with a drill a few milli- 
meters from the edge of the surface to be divided. The two halves of the 
jaw are widely separated, and the tongue drawn out of the mouth and 
toward the healthy side by means of the silk retractor. The mucous 
membrane of the floor of the mouth is then divided backward as far as the 
tonsillar fold on both sides. Ligate the lingual artery and vein, and divide 
the hypoglossal nerve as it crosses the hyoglossus muscle. The lingual 
artery passes forward and upward between the hyoglossus and the genio- 
hyoglossus muscles, where it is ligated. The hyoglossus muscle is divided, 
as in all muscular incisions, immediately outside the limits of the growths, 
and the edges cauterized. The tongue is then pulled forward, and 
the mucous membrane divided in the posterior surface of the mouth; 
the styloglossus muscle and glossopharyngeal nerve are now divided. 
Lastly, the tongue is cut through, where it is healthy, with the thermo- 
cauter and the nerves, muscles, and vessels (previously ligated) are cut 
through on the under surface. The nerves and muscles are preserved as 
much as possible, in order not to interfere with the mechanism of swallow- 
ing more than is necessary. The two halves of the jaw are then approxi- 
mated, and silver wire pushed through the holes previously drilled, and 



304 SURGERY 

the edges of the jaw firmly wired. Always leave a silk suture through the 
stump of the tongue in case the patient should swallow it. The cutaneous 
wound is closed by sutures, excepting at the lower end, where a strip of 
gauze is left for drainage. Dressings are applied, and the patient kept in a 
sloping position as long as swallowing is much interfered with. 

What glandular structures are most commonly affected in 
carcinoma of the anterior portion of the tongue? 

The submental lymphatic glands, the submaxillary, and the glands 
beneath the sternomastoid muscle. The sublingual and submaxillary 
salivary glands may also be involved. 

Give the etiology and clinical features of epithelioma of 
the lip. 

Etiology. — Irritation, such as smoking a short clay pipe; or an irregu- 
lar, rough tooth. 

Clinically, it resembles in its early stage a simple ulcer, which grad- 
ually becomes more irregular, indurated, and necrotic. It is usually 
situated upon the lower lip, and occurs almost exclusively in men. The 
submental and submaxillary glands are usually enlarged. 

Give the treatment of injuries of the mouth caused by car- 
bolic acid. 

Apply immediately alcohol or whiskey, and later keep the mouth as 
clean as possible with an antiseptic mouth wash. Any contractures that 
may occur should be dealt with after the acute symptoms have subsided. 

What are the indications for the use of the lance in deciduous 
dentition? 

The gums should never be lanced until a distinct white line is apparent. 

How would you treat a case of external fistula with adhesions 
from an alveolar abscess? 

The entire fistulous tract should be dissected out, all scar tissue and 
sequestra removed, the area drained into the mouth, and the skin closed. 

Give the diagnosis and treatment of salivary calculus. 

There is marked dilatation of the duct and on probing a gritty sensation 
is conveyed to the finger. A small amount of saliva may usually be 
forced around the calculus by firm pressure with the fingers. 

Treatment. — Excision of the calculus from the inside of the mouth. 

Give the symptoms and treatment of alveolar abscess after 
infection has taken place. 

Symptoms. — Severe throbbing pain, redness and swelling of the gums, 
increased local temperature, and tenderness on percussing the tooth, 
which may or may not be loose in its socket. 

Treatment. — Extract the infected tooth and syringe frequently with 
salt solution. If after several weeks of treatment the infection still per- 
sists, curet the cavity. 



PYORRHEA ALVKOLARIS 305 

Describe the operation for the removal of an impacted 
inferior third molar tooth. 

Depending upon the position and direction of the tooth, it may be 
necessary to remove the second molar, or drill away the portion of the 
alveolar process above the tooth and then extract. 

What is pyorrhea alveolaris? Give the etiology and treat- 
ment. 

Pyorrhea alveolaris is an inflammatory condition of the margins of the 
gums, accompanied by a muco-purulent discharge, which arises from 
pockets or pouches extending for a greater or less distance along the 
roots of the teeth. 

Etiology. — Gout, uric acid, diabetes, certain conditions of diet, and 
irregularities of the teeth might be mentioned as predisposing factors. 
It is always preceded by an excessive deposit of tartar, beneath which 
bacterial infection occurs. 

Treatment. — Thoroughly cleanse the teeth and remove all tartar with 
appropriately shaped scalers and chisels (see page 335), especially under 
the gums. This is the most important part of the treatment, and all 
other measures are merely supplementary. Loose teeth may require 
ligatures or splints. After the tartar has been removed, the pus-pockets 
at the gingival edges must be cleansed with hot water and injected with 
emetin hydrochloride in 1/2 of I per cent, aqueous solution. This is done 
with a blunt hypodermic syringe, the emetin being introduced freely into 
the pockets, but not into the tissue of the gums. Emetin has superseded 
all other drugs for this purpose. It may, in addition, be adminis- 
tered systemically by hypodermic injection in the dose of 1/4 to 1/2 
grain. 

Autogenous vaccines, prepared from the pyogenic organisms found in 
the pus-pockets, have also been used with apparent good effect as an 
adjuvant to the local treatment, and are strongly recommended in some 
quarters. 

The treatment is prolonged and tedious, and success depends chiefly 
on the thoroughness with which the local measures are carried out. 
Constitutional treatment to correct any faulty diathesis that may be 
present should not be neglected. The patient should be instructed to use 
thrice daily a mouth- wash containing zinc chlorid. 

What pathogenic organisms are found in the mouth in cases 
of pyorrhoea alveolaris? 

Entamoeba gingivalis is present in most cases, but its etiologic rela- 
tion to the disease is not absolutely established. Other organisms are a 
fusiform bacillus, a spirillum resembling the organism of Vincent's angina, 
streptococci, and staphylococci. 

Give the symptoms and treatment of rickets. 

Rickets is a disease of childhood affecting chiefly the osseous system 
and due to mal-nutrition. 

Symptoms. — General irritability; loss of weight and strength; enlarge- 
ment of the abdomen and liver; thickening of the costal ends of the costal 
cartilages, etc., epiphyseal lines of the bones; the fontanelles fail to close. 



306 SURGERY 

The incisor teeth frequently develop transverse striation and at times 
resemble Hutchinson's teeth. 

Treatment. — Fresh air. Correct the diet, as to quality and quantity. 
Internally administer iron. 

Describe trismus, and how it differs from tetanus. 

Trismus is a spasmodic locking of the jaws. It is frequently due to 
neuralgia, an impacted third molar, or inflammation of the roots of the 
teeth. 

Tetanus is an acute infectious disease, with tonic spasm of the muscles 
of the mouth and jaws, associated with general spasm of the muscles. 

What is the treatment of diphtheric stenosis of the larynx? 

The usual treatment of diphtheria should be instituted or continued 
Injection of diphtheric antitoxin, administration of whisky, hypodermic 
injections of strychnin, absolute rest in bed, and fluid diet. In sten- 
osis intubation should be performed immediately. If the tube becomes 
plugged continuously or coughed up frequently each day, tracheotomy 
should be performed. 

How would you perform tracheotomy? 

Place the patient in the dorsal position, with the head extended over 
a sand-bag. An assistant holds the head in the middle line. Make an 
incision in the middle line about 2 in. long from the cricoid cartilage down- 
ward, through the skin, superficial and deep fascia; separate the sterno- 
hyoid muscles, and divide the pretracheal fascia. Stop the hemorrhage 
and retract the isthmus of the thyroid downward. Steady the tracheal 
rings with a tenaculum, incise the second and third rings from below 
upward, insert the tube with the obturator, remove the obturator, and 
insert the inner tube. 

State the causes of exophthalmos. 

Exophthalmic goiter, intra-orbital aneurysm, intra-orbital tumors, 
thrombosis of the cavernous sinus, fracture of the anterior fossa with 
laceration of the cavernous sinus, emphysema of the antrum, tumors of 
the antrum. 

What are the indications for thyroidectomy? 

Fibro-adenomatous and cystic goiters, parenchymatous goiters which 
increase in size in spite of palliative treatment, carcinoma and sarcoma 
of the thyroid gland, and exophthalmic goiter in selected cases. 

What are the causes of dysphagia? 

1. Pharyngeal. — Acute or chronic inflammation, tuberculosis, syphilis, 
malignant growths, paralysis, nasopharyngeal polypi, and impaction of 
foreign bodies. 

2. Laryngeal. — Acute or chronic inflammation, tuberculosis, syphilis, 
and malignant growths. 

3. Esophageal. — Acute or chronic inflammation, impaction of foreign 
bodies, the presence of diverticula, esophagospasm, simple or malignant 



LUPUS 307 

stricture. Pressure from without caused by aneurysm, goiter, enlarged 
glands, mediastinal growths, pericardial effusion, and tumors of the ver- 
tebra-. 

What is lupus? 

Lupus vulgaris is a chronic inflammatory disease of the skin and 
mucous membranes due to the tubercle bacillus, and characterized by the 
formation of nodules of granulation tissue. Frequently these nodules 
ulcerate. 

Describe two methods of sterilizing instruments. 

First method: Boil ten minutes in a 1 per cent, solution of sodium 
carbonate. For instruments with a sharp edge, or wooden and ivory 
handles, this method is not recommended, as it will dull the edge and 
destroy the wood or ivory. 

Second method: Carefully scrub the instruments with soap and water 
and place in a 70 per cent, solution of alcohol for twenty minutes. 

When would you use the X=ray therapeutically, and how 
treat the burn, if such a case came to you? 

Indications: epithelioma of the face; certain cutaneous diseases, such 
as acne, lupus erythematodes; leukemia; as a post-operative procedure 
after surgical removal of carcinomatous growths in any part of the body. 

If a burn occurs, stop X-ray treatment at once, protect the part from 
pressure and irritation, and dress with boric ointment. 

Give a detailed statement as to the value of the X=ray as an 
aid to surgical diagnosis. 

Rontgenography is of value in the study of fractures and dislocations; 
the size and density of bony tumors; the pressure, position, and size of 
foreign bodies; shape and position of the teeth. The shape and position 
of any part of the intestinal canal can be determined by giving bismuth 
by mouth before taking the photograph. The depth, size, and position 
of fistulous tracts can be determined by first injecting them with bis- 
muth paste. In infections of accessory sinuses of the head, a shadow can 
be obtained that will assist in the diagnosis. 

Describe Barton's bandage. 

It is a figure-of-eight of the jaw and occiput. The bandage should be 
two inches wide and five yards long. Place the initial extremity of the 
bandage behind the external occipital protuberance; pass over the right 
parietal bone, across the vertex, down the left side in front of the ears, 
under the chin, up the right side in front of the ear, across the vertex, 
and across the left parietal bone to the point of origin; a turn is now taken 
forward along the right side of the jaw to the chin, and backward along 
the left side of the jaw from the chin to the nape of the neck. Repeat 
these turns and pin the points of junction. 

Describe the Gibson bandage. 

Use a two inch roller bandage, six yards long. Make three vertical 



308 SURGERY 

turns around the head and jaw in front of the ear; reverse the 
bandage above the level of the ear, and carry it horizontally around the 
forehead and head three times; drop the bandage to the nape of the 
neck, and take three turns around the neck and jaw; terminate by 
taking from the nape of the neck a half turn upward, carrying the ban- 
dage forward to the forehead, and pinning it over the neck and over 
the forehead. 

What is the cause of syphilis? 

Treponema pallidum, discovered by Schaudinn and Hoffman in 1905. 
The organism is from 6 to 15 micromillimeters in length and presents 
from 6 to 14 spiral turns. It is found most frequently in primary and 
secondary, and rarely in tertiary lesions. Its presence in a suspected 
lesion is regarded as diagnostic, while its absence does not exclude 
syphilis. 

Describe a syphilitic mucous patch. 

A flat or slightly convex grayish-white elevation, the surface of which 
resembles mucous membrane; it secretes a mucopurulent, highly con- 
tagious discharge; mucous patches are situated on the lips, tongue, gums, 
on the inside of the cheeks and the hard and soft palate. 

Describe a syphilitic ulcer of the tongue. 

It is usually situated at the side or tip of the tongue; the edges are 
undermined, giving a punched out appearance. Syphilitic ulcers are 
usually multiple and tend to recur; they belong to the secondary and 
tertiary stages. Syphilitic lesions in the mouth and other portions of the 
body may be associated with the above lesion. 

Mention the syphilitic lesions of bone. In what stage of 
syphilis do these lesions occur? 

Osteo-periostitis, osteomyelelitis, and gumma. 
Usually in the third stage and in hereditary lues. 

Give a brief description of syphilis. 

Syphilis is a chronic infectious, contagious, and inoculable disease, 
transmissible by direct contact of abraded surfaces. It first manifests 
itself by an indurated chancre at the point where the causal agent enters 
the body; this is accompanied by enlargement of the neighboring lymph- 
nodes which may suppurate {buboes), and, after an interval of some weeks, 
by symptoms of general infection — moderate fever, headache, malaise 
and general pains, sometimes swelling of the spleen — and characteristic 
eruptions on the skin and mucous membranes {mucous patches in the 
mouth). These symptoms subside and the disease may be arrested or, 
after the lapse of some years, localized, so-called tertiary lesions develop 
in any part of the body, especially the bones and the nervous system, 
which may be attacked by one of the parasyphilitic afections or para- 
syphiloses (tabes dorsalis, general progressive paralysis). Heredo syphilis 
is transmitted to the fetus through the placental blood, and a child so 
affected is practically in the tertiary stage of the disease. 



SYPHILIS 309 

Name the different stages of syphilis, and give the incubation 
period. 

Incubation, from seven to fourteen days. 

I : irst Stage. — The chancre appears at the point of infection. 

The second stage appears in from six weeks to three months after the 
chancre. It is characterized by mucous patches, skin eruptions, lo 
hair, decrease in weight, bone pains at night, and lymphatic enlargement. 

Third Stage. — It may appear any time from three months to three 
years after inoculation and is characterized by chronic inflammation of 
bones, skin eruptions, loss of hair, and changes in the nervous system. 

Hereditary Syphilis. — Syphilis may be inherited from the father or 
mother and is characterized by skin eruptions, enlargement of the liver, 
loss of weight and strength, deformity of the teeth (Hutchinson's teeth), 
and various eye lesions (keratitis, iritis, etc.). 

Give the name of the blood serum test and state its value. 

The Wassermann Test. — A positive test strongly suggests the presence 
of syphilis, but is not an absolute proof of the existence of the disease (see 
page 232). 

Give the diagnosis and treatment of chancre of the lip. 

Chancre is very similar to an ulcer, the edges are hard and indurated. 
Constitutional symptoms consist in slight fever at night, headache and, 
later, rash and mucous patches, enlargement of lymph-nodes. 

Treatment. — Locally, a peroxid mouth-wash; internally, mercury; or 
hypodermatically, salicylate of mercury. Arsenobenzol (salvarsan), ad- 
ministered intravenously, is the most efficient antisyphilitic in the 
primary and secondary stages. 

State the precautions that should be taken when operating 
upon syphilitic patients. 

If possible, the patient should have anti-syphilitic treatment. The 
operator should wear rubber gloves. Before putting on the rubber gloves 
his hands should be covered with a 25 per cent, calomel ointment. At the 
conclusion of the operation the hands should be scrubbed carefully, and 
washed in alcohol for five minutes, and again rubbed with 25 per cent, 
calomel ointment. 

Give the symptoms and treatment of mercurial stomatitis. 

Symptoms. — The patient complains first of a metallic taste in the 
mouth, the gums become swollen, red, and sore, mastication is difficult, 
and soon there is a great increase in the secretion of the saliva which flows 
freely from the mouth. The tongue is swollen, the breath has a foul odor, 
and, if the affection progresses there may be ulceration of the mucosa. 
Rarely the teeth become loose and necrosis of the jaw develops. 

Treatment. — Stop the administration of mercury. Give potassium 
chlorate internally, and as a mouth wash. Moderate doses of atropin 
and hot baths. 

What agents are employed for the production of general 
anesthesia? 

Nitrous oxid, ether, chloroform, ethyl chlorid, somnoform, (scopo- 
lamin-morphin, morphin). 



309a SURGERY 

What are the contraindications respectively to the use of 
the three principal general anesthetics? 

Nitrous oxid is counterindicated in arteriosclerosis; ether, in pulmon- 
ary and renal disease; chloroform in disease of the heart. 

What are the various methods of administering ether? 

Ether may be administered by the open or by the closed method, the 
former being practically universal in this country. The administration of 
ether may be preceded by the inhalation of nitrous oxid, ethyl chlorid, or 
chloroform (mixed anesthesia). 

What agents are employed for the production of local 
anesthesia? 

Ice and salt, ethyl chlorid, cocain, novocain, and eucain by infiltra- 
tion or direct application, or by injection into the sub-dural space to pro- 
duce so-called spinal anesthesia. 

How should chloroform be administered? Ether? What 
accidents may occur? Give treatment. 

Chloroform should be administered with an open mask, drop by drop, 
until the patient is anesthetized, at all times watching the pulse. 

Ether should be administered through a cone or gauze, drop by drop, 
until the reflexes are abolished, being careful to note the respiration and 
pulse. Accidents from chloroform are usually of the cardiac type, and 
death is sudden. Ether death usually results from respiratory, although 
it may be from cardiac paralysis. In both instances one should be 
careful that vomitus is not drained into the larynx and the patient drowned 
in his own excretions. 

The treatment consists in the administration by inhalation of ammonia, 
strychnin and digitalis hypodermically, the application of electricity, 
and artificial respiration. 

State what physical conditions contraindicate general 
anesthesia. 

Disease of the heart; arteriosclerosis; pulmonary or renal disease; 
severe anemia. 

How is the muscular system affected in complete anesthesia, 
(a) under ether, (b) under nitrous oxid? 

A complete relaxation of all muscles excepting the cardiac muscle. 

What anesthetic would you select for an operation about the 
mouth? 

1'Jlier. — It is the least dangerous and its one disadvantage (increased 
flow of saliva) can be overcome by giving morphin and atropin one-half 
hour before beginning the anesthetization. Chloroform is used in warm 
climates with satisfactory results, but careful records show that it is 
much more dangerous than ether. 

Mention and describe briefly a method of anesthetization 
suitable for dental operations. 

The administration of nitrons oxid and oxygen to the point of analgesia. 



ANESTHESIA 300& 

The mixture of gases should contain from 15 to 20 per cent, oxygen and 

80 to 85 per cent, nitrous oxid. 

The mask is applied firmly over the nose and held in position by means 
of elastic straps. The patient is instructed to inhale deeply several times 

through the nose until he feels a numbness in the linker-tips, and then 
breathe naturally through the mouth, alternating in this manner so as to 
maintain a state of analgesia — which he can gauge by his own sensations 
— but which falls short of complete anesthesia and loss of consciousness. 
The operator must watch the patient closely for signs of impending as- 
phyxia, cyanosis being the signal for increasing the proportion of oxygen 
or withdrawing the anesthetic. 

The method is suitable for such operations as preparing a cavity for 
filling in adult patients, and occasionally in older children of sufficient 
intelligence to be instructed how to control the breathing. The usual 
precautions necessary during the administration of nitrous oxid must, of 
course, be observed (see question on page 310). 

Describe the necessary preparation of patients for general 
anesthesia. State what remedies and instruments should be 
at hand. 

An examination of the heart, lungs and urine should be made, if 
possible, the day before. The night before the operation, the patient 
should receive a laxative. No food should be taken for at least four 
hours before taking the anesthetic. Immediately before administering 
the anesthetic false teeth, loose bridges, etc., should be removed from 
the mouth. 

Instruments and Remedies. — A mouth gag and tongue forceps. A 
hypodermic syringe and tablets of strychnin and digitalis. A cylinder of 
oxygen with attachments for inhalation should always be ready at hand. 

Which of the following is used as a general anesthetic; 
acetic ether, sulfuric ether? How is it prepared? What is 
its physiologic action when used as an anesthetic? 

(a) Sulfuric ether. 

(b) Sulfuric ether (ethyl oxid) is a colorless, very volatile liquid, ob- 
tained by the dehydration of alcohol by sulfuric acid. 

The first effects are burning in the fauces due to the irritating vapor. 
The primary systemic action is a sense of exhilaration, rapidly succeeded 
by semi-consciousness. The pulse is at first quickened and increased in 
force. The respirations are at first accelerated as well as deepened, but 
as complete anesthesia is reached, they become normal. If the anes- 
thesia becomes too deep they gradually become more and more shallow 
and slower. The reflexes are at first increased, but later are abolished. 
The arterial pressure is at first increased, but later depressed. 

Of what is chloroform composed? (b) Give the successive 
steps necessary for chloroform anesthesia, from the preparation 
of the patient to the induction of complete anesthesia. 

The chemical formula is CHC1 3 . It is a colorless, neutral fluid 
produced by the action of chlorin upon alcohol. 



3IO SURGERY 

(b) Examine the mouth for foreign bodies. Examine the heart, 
lungs, and eyes. Apply petrolatum to the face to prevent irritation of 
the skin. Place a mask about three inches over the nose and mouth, 
drop the chloroform drop by drop, and at the same time gradually 
lower the mask until it rests upon the face. Carefully note conditions 
of pulse and respiration. When anesthesia is complete, remove the 
mask, cover the patient carefully, and remain with the patient until he is 
conscious. 

Describe the three stages of anesthesia under ether. 

First or analgesic stage, characterized by excitation, emotional dis- 
turbances, e.g., laughter and crying, increased reilexes, rise of blood 
pressure. Respiration increased but regular and free, unless interfered 
with by irritation of anesthetic or coughing. Pupils slightly dilated. 
— Second or stage of ligJit anestliesia: Complete loss of consciousness, 
muttering, deep respiration, muscular spasm, reflexes still present, 
pupils normal. — Third stage or narcosis: General muscular relaxation; 
regular breathing; loss of corneal reflex; pupils moderately dilated. 

Give precautions to be observed before and during the 
administration of nitrous oxid. 

Examine the heart and lungs, remove all foreign bodies from the 
the mouth, note pulse, color and respiration. 

In case of collapse during general anesthesia, which ceases 
first, respiration or heart action? 

Usually respiration; in chloroform anesthesia, sometimes the heart 
action. 

State indications of complete anesthesia under nitrous oxid, 
(b) period of induction, (c) average period of anesthesia. 

Extraction of one or more teeth, opening an abscess, breaking up 
adhesions in a joint, etc. Combined with oxygen, nitrous oxid is some- 
times used for major operations. 

(b) About thirty seconds. 

(c) About fifty-six seconds. 

What are the advantages and the disadvantages in the use 
of chloroform as an anesthetic in tooth extraction? State 
symptoms of danger, and treatment in case of collapse. 

Advantages. — Anesthesia is produced rapidly, the stage of excitation 
is very short and mild, and recovery from the anesthetic is rapid. There 
is no increased flow of saliva. 

Disadvantages. — Collapse, if it occurs, is sudden and difficult to 
treat. The mortality is higher than when ether or nitrous oxid is used. 

Describe the different stages in the production of general 
anesthesia. How do these stages differ in the use of chloroform, 
ether, and nitrous oxid? 

See former question. 



ANESTHESIA 311 

Chloroform. — Short first and second stages, with less excitement, and 
rapid recovery after the inhaler is removed. 

Nitrous Ox id. — Very short first and second stages, with increased 
rate and depth of respiration during the first stage. The third stage 
cannot be prolonged beyond a very few minutes without the addition 
of oxygen. 

State characteristic manifestations of danger during the 
administration of (a) chloroform, (b) of ether, (c) of nitrous 
oxid. 

(a) Markedly dilated and fixed pupils. Irregular and rapid pulse. 

(b) Dark bluish color; irregular and slow respiration, irregular and 
rapid pulse, dilated pupils. 

(c) Shallow or absent respiration, and signs of asphyxia. 

Give the physiological effects of nitrous oxid. 

Nitrous oxid does not produce anesthesia by asphyxia, but by direct 
absorption of the gas associated with a diminished supply of oxygen. 
The blood pressure is markedly raised. Death, if it occurs, is usually 
due to asphyxia. 

Define asphyxia. Give treatment. 

Asphyxia is suffocation, or more or less complete deficiency of oxygen 
in the blood. 

Treatment. — Remove any obstruction in the respiratory tract and per- 
form artificial respiration, at the same time giving stimulants hypoder- 
matically. 

What produces mechanical asphyxia during anesthesia? 

It is usually due to the tongue falling backward, and in this way closing 
the glottis. It may be due to foreign bodies, such as a dental plate or 
bridge. 

Give the etiology and treatment of syncope. 

Syncope is due to anemia of the brain, and is caused by fright, pain, 
or fear. 

Treatment. — Place the head low; administer smelling salts, and apply 
heat to the body. 

Describe fully two methods for producing local anesthesia 
of the skin. 

First. — By freezing with ethyl-chlorid. 

Second. — By hypodermic injection of a i per cent, solution of cocain 
or eucain into the area to be anesthetized or into the nerve supplying 
the part. 

Give two methods for producing local anesthesia of mucous 
membrane. 

Direct application of cocain or other local anesthetic. 
Hypodermic injection of the anesthetic. 



312 SURGERY 

What is ethyl chlorid? Describe method of producing local 
anesthesia by its use, and state precautions to be observed. 

(a) An extremely volatile liquid, also called kelene (C 2 H 5 C1), boiling 
at about 12 C. It is obtained by the action of hydrochloric acid on 
absolute ethyl alcohol. 

(b) Dry the area carefully and spray with ethyl chlorid until com- 
pletely blanched. Do not continue the spraying or repeat more than 
once, as sloughing may occur. 



ORTHODONTIA 



What is dental orthopcdia? 

The treatment and correction of facial deformities by means of appli- 
ances on the teeth and jaws. 

What are the principal causes of irregularities in teeth? 

Premature loss or prolonged retention of deciduous teeth, tardy 
eruption or loss of permanent teeth, imperfect fillings, crowns, etc., nasal 
obstructions, habit, disuse, abnormal frenum labium. 

Mention some of the facial muscles that affect the formation 
of the superior dental arch. 

Buccinator, orbicularis oris, masseter, levator and depressor anguli 
oris, zygomaticus major and minor. 

Differentiate the terms occlusion and articulation. 

Occlusion is relative position of the individual teeth of the opposing 
arches, the cusps of the teeth in one jaw fitting in sulci of teeth in the 
other. Articulation is the relative position of the two jaw T s in the various 
movements of mastication. 

What teeth are the key to normal occlusion? (b) Give the 
occlusal relation of these teeth. 

The first molars, (b) The inferior first molar should occlude with 
the anterior two-thirds of the superior first molar and the posterior third 
of the second bicuspid, the distobuccal cusp occluding in the sulci of the 
superior molar and the mesiobuccal cusp in the interspace between molar 
and bicuspid. 

Describe Dr. Angle's "line of occlusion," showing the 
greatest number of points of contact in a normal occlusion. 

It is "the line with which, in form and position according to type, 
the teeth must be in harmony, if in normal occlusion." 

In prosthetic dentistry, what is meant by "re=posing the 
features?" 

By the term " re-posing the features" w r e include everything nec- 
essary to bring each and all of the visible parts of the face and mouth 
into harmony of relation to each other. (Warren's Dental Prosthesis). 

Describe a simple but accurate method of securing a profile 
record of the face in regulating cases. 

The camera affords the simplest and most accurate means, if the 
orthodontist be properly equipped. In the absence of a camera, a soft 

3*3 



314 ORTHODONTIA 

lead wire should be moulded with the fingers to the profile. Starting 
above the forehead, the wire is bent to gently touch the skin at all points 
of the median line down to the larynx. The wire is now carefully laid on 
a piece of cardboard and the outline traced with a sharp pencil. It 
may be preserved in this form or cut out along pencil line and held to 
the face for verification. 

Describe the condition of the teeth and appearance of the 
roof of the mouth in a case of chronic hypertrophy in the naso=> 
pharynx. 

The central incisors protrude and are rotated, meeting at their mesio- 
incisal angles. The lateral incisors are crowded slightly behind the 
centrals. The arch is narrow and pointed and the roof of the mouth 
very high. 

What should be the first procedure in the correction of an 
irregularity? 

Accurate models should first be secured for study and reference. 
The cause of the irregularity should be determined and the method of 
treatment decided upon. 

What is the prospect of successfully correcting malocclusion 
without first removing nasal obstructions? 

Nasal obstructions should first be removed. In the habitual mouth- 
breather we lose most of the natural retention of the interlocking of 
occluding cusps. Permanent retention is therefore uncertain if nasal 
obstructions are not removed. 

What conditions of the superior maxilla and of the teeth are 
caused by the retention of adenoids and enlarged tonsils? 

The maxillae are compressed laterally, the arch being narrow; the 
palate is high and the incisors protrude, their mesio-incisive angles 
being protruded and in contact. 

For convenience of diagnosis, what two points have been 
selected by Dr. Angle from which to note variation from the 
normal in the arches? 

"The normal mesiodistal relations of the cuspids and of the mesio- 
buccal cusps of the upper first molars." (Angle). 

Describe the facial "line of harmony" according to Dr. 
Angle. 

It is the harmonious line of the profile shown by drawing a straight 
line through the features. In a face, the features of which are harmon- 
ious, the line should touch the forehead, pass through the middle of the 
wing of the nose, through the outer edge of the upper lip, just touching 
the lower lip and the chin. 

Describe a form of malocclusion caused by an abnormal 
frenum labium. 

Abnormal separation of the central incisors due to the enlargement 
and motion of the abnormal frenum. 



\IT1 I W I - 315 

Why arc the bicuspids less liable to Irregularity than the 
other teeth? 

Owing to the flatness of their roots the lateral .support is greater and 

the tendency to rotation lessened. 

What are the three principal effects to be secured in the 
treatment of cases of malocclusion? 

The restoration of the teeth to the "line of occlusion," the restora- 
tion of the " facial line of harmony," and the permanent establishing 
of these conditions. 

What is the relation of the lower to the upper arch in Dr. 
Angle's Class 2 of malocclusions? 

The lower teeth are in distal occlusion to the upper. 

At what age is regulating the teeth permissible? 

Not earlier than the ninth year. Between the twelfth and four- 
teenth is better. 

State the six directions in which the various teeth may be 
moved in adjusting irregularities. 

Backward, forward, outward, inward, upward, and downward. 

What general principles should be observed in the con= 
struction of appliances used in orthodontia? 

They should have these requisite qualifications, namely: Efficiency, 
simplicity, delicacy, inconspicuousness, and stability. 

State the principle of Farrar's system of regulating. 

The movement of teeth by positive force, such as jack screws. Rest 
should follow motion. 

Describe the Magill band and its method of attachment. 

It is a simple "pinch" band. A strip of metal, in width the height 
of the crown is bent around the tooth, the ends grasped with pliers and 
pinched together. The band is then removed and soldered at the joint. It 
is attached to the tooth with cement. 

Describe a labial bow and hook=band and its application for 
rotating a lateral incisor tooth. 

The second bicuspid on each side is banded, the bands having tubes 
soldered to the buccal surfaces. The ends of the labial bow are passed 
through the tubes, nuts being threaded on at each end of tube. The lateral 
band should have a hook soldered on the lingual surface, over which a 
rubber band is slipped and ligated to the bow. 

State a method of rotating a lateral incisor. 

The lateral is banded with a lug on the labial surface. A rubber band 
is stretched from this lug around the lingual surface and over a lug 
soldered to a band on the second bicuspid. 



316 ORTHODONTIA 

Describe the Jackson crib and base wire. 

It consists of wire cribs on the molars and a base wire bent in an arch 
or bow around the lingual surfaces of the teeth. Piano wire springs are 
soldered to this bow and connected to the teeth to be moved. 

How great should be the force exerted in moving a tooth? 

Sufficient to accomplish the desired movement without causing 
i nil animation. The movement should be slow enough to permit the 
tissue changes in socket. 

Mention some of the arguments in favor of the application of 
steady pressure as against intermittent pressure in the move= 
ment of teeth. 

The force need not be so great owing to the fact that, when the 
movement is once established, it is maintained with less pressure than is 
needed to start the movement. The pressure being less, the inflammatory 
conditions are greatly reduced. The time consumed is less because the 
force is always active and the amount of operative procedure is lessened. 

What occurs, besides change of position, when a tooth is 
rotated in its socket? 

The principal changes are: Absorption of the bone, the stretching of 
the peridental fibers along the entire length of the root that directly 
resist this movement, and deposition of new bone to form the socket in its 
new relation. 

Describe the Matteson lingual bow and give method of 
attachment for moving the upper central incisors forward. 

It is a bow or half bow of piano wire, one end of which is inserted in a 
tube, which has one end closed and soldered to molar and bicuspid 
bands, while the other end engages with flat lugs cemented to bands on 
the teeth to be moved. 

Describe the Norton=Talbot spring and give the method of 
using it in expanding the arch. 

It is a coiled spring of piano w T ire. Several teeth on each side of the 
arch are banded, a bar connecting the bands on the lingual surface. The 
two ends of the spring are inserted into holes in the bars. The constant 
pressure of the expanding spring widens the arch. 

How can the upper arch be expanded? 

By means of an expansion arch attached to bands on the second molar 
and ligated to first b cuspid on each side, a bar extending from molar 
band to bicuspid band on the palatal surface. 

What injury may occur from the use of too much force in 
spreading the arch? 

Separation of the maxillary bones at the intermaxillary suture. 

What do you understand by the term prognathism? 

Abnormal protrusion of the jaws. 



PROGNATHISM 317 

Describe the treatment of prognathism. 

The treatment consists in retracting the jaw by means of a swaged metal 
cap fitted to the chin and connected by elastic bands to a net-like cap 
worn on the back of the head. The constant traction of the elastic bands 
with resultant pressure on the chin causes absorption of the posterior 
wall of the glenoid fossa, and bending of the ramus and necks of the 
condyles, until the upper and lower jaw are in correct relation. In extreme 
cases, a wedge-shape piece is sometimes cut from the ramus, the jaw 
forced to proper articulation and held till the bone has knit. 

Describe an occipital appliance and yoke used for retracting 
and shortening the upper central incisors. 

A lingual bar is bent around the arch passing through tubes soldered 
to bands on the molars and resting in notched lugs on the labial surfaces of 
bands encircling the central incisors. In the center of the arch or bow is 
soldered a collar with a round headed lug to engage the socket in the 
yoke. The yoke consists of a nickle-plated bar about six inches in length, 
curved at each end and finally bent back to form a hook. The yoke re- 
sembles very much the milk-maid's yoke used to carry a pail on each end. 
In the center is a movable collar carrying a short bar (about a half inch 
in length) , the end of which is countersunk to fit over round head lug on 
the labial bow. The occipital cap is constructed of net and is attached to a 
wire frame fashioned to fit the back of the head and nape of the neck. Two 
or three elastic bands are fastened to the wire frame, one passing under 
the ear, one above, and the third if used directly over the ear. These bands 
are brought forward and fastened to the hooked ends of the yoke. 
(Edward H. Angle.) 

How may an unerupted cuspid tooth be drawn into position? 

The gum is lanced to expose crown of cuspid. A small hole is drilled 
in the palatal surface and a gold screw, hook shaped, is cemented in. The 
lateral and bicuspid are banded and a bar soldered, running from band 
to band. A rubber band is stretched from bar to hook, causing constant 
steady traction. 

Describe Dr. Case's appliance for raising the occlusion of the 
lower bicuspids. 

The second molar on each side is banded. The bands have tubes 
soldered to the buccal surfaces, and a spring bow, bent around the anterior 
teeth, passes through the tubes. The bioispids are banded with bands 
having hooks turned down on the buccal surfaces. The incisors are 
banded with bands having hooks turned up on the labial surface. The bow 
is sprung under the bicuspid hooks and over the incisor hooks. 

Give a method of elongating bicuspids when they fail to 
occlude properly. 

The upper and lower bicuspids may be banded, lugs or hooks being 
soldered to the buccal surfaces of the bands. Rubber bands are stretched 
from the lugs on the upper, to those on the lower bicuspids. The constant 
traction of the rubber brings the teeth to occlusion. 



318 ORTHODONTIA 

Describe Dr. Farrar's appliance for moving roots back. 

"The crowns are stayed by an inside rectangular frame resting in 
V-shaped lugs at the ends of crowns and braced against nuts soldered to 
two anchor clamp-bands on the side teeth. The roots are drawn back by 
a labial bow attached to the clamp-bands by screws." (American Text- 
Book). 

Describe Dr. Farrar's appliance for moving roots forward. 

"The base of support is a transpalatal jack-screw, anchored by two 
clamp bands that embrace the side teeth; from this jack to the posterior 
sides of the necks of the incisors are two other screw jacks to press 
against the front teeth. To hold these jacks upon them a broad band 
with a V=shaped lug soldered on the lingual side is cemented to each 
incisor in which a bar connecting the anterior ends of the jack rests. To 
hold firmly the end of the crown of each incisor, and to prevent them 
from moving forward when the jacks are set at work against the necks 
of the teeth, the ends are tied to the transpalatal jack by two wire cords 
connected with a cross bar lodged in other V=shaped lugs soldered to 
the labial side of the bands." (American Text-Book of Operative 
Dentistry). 

What is the principle of the incline plane? 

The natural incline planes are the sides of the cusps of the teeth. 
They guide the opposing cusps to their natural position in the sulci and 
interspaces. An artificial incline plane is a metal plate or bar so placed 
that in closing the jaw one or more teeth will impinge on it and be forced 
to occlude in a changed relation. 

Describe a method of bringing into proper position a right 
upper cuspid that bites inside the circle of the lower teeth. 

A jack-screw may be adjusted from the opposite first molar to the 
palatal surface of the cuspid. Temporary caps are cemented on the 
molar teeth of each side to raise the bite. Gradually lengthening the 
screw will force the cuspid out when the caps are removed. The constant 
pressure of the lower teeth will prevent the cuspid returning to its original 
position. 

Describe the articulation of the upper and lower teeth in a 
case of protruding mandible. What teeth usually occlude 
perfectly? Is mouth breathing an accompaniment of this 
condition. 

The mesiobuccal cusp of the upper first molar occludes in the inter- 
space between the lower first and second molars. Mouth breathing 
seldom if ever accompanies this condition. (Reference to Angle's books 
fails to reveal any cases in this class where any of the teeth were in "per- 
fect occlusion. ") 

What may cause the superior incisors to close within the 
inferior incisors? 

The early loss of upper bicuspids or cuspids, faulty or lack of eruption 
of canines, and eruption of lower first molar anterior to upper first molar. 



ANCHORAGE 319 

In the latter case the mesiobuccal cusp of the upper first molar forcing 
against the distal plane of the distobuccal cusp of the lower first molar 
would cause protrusion of the mandible and consequent anterior ar- 
ticulation. 

Describe the Angle method of retracting a protruding lower 
jaw. 

The first lower molars are banded and traction screws attached, the 
bars of which hook into rings soldered on bands encircling the cuspids. 
The cuspid bands are connected by a wire which runs in front of the 
anterior teeth. An impression of the chin is taken, a die made and a chin 
cap of aluminum swaged. This is perforated and attached by elastic bands 
to a net cap worn far back on the head. 

Describe the process of correcting a case of infra=occlusion 
or lack of anterior occlusion. 

Anchor bands carrying tubes on their buccal surfaces are attached to 
the upper first molars and a labial bow placed in position in the tubes. 
Bands on the cuspids have hooks turned down and those on the incisors 
hooks turned up. The bow is hooked over the incisor hooks and sprung 
under the cuspid hooks. The cuspid acts as a fulcrum, the bow as a 
lever, and the incisors are forced to occlusion. In extreme cases the lower 
jaw may be treated with the same type of appliance, the position of the 
hooks being reversed. 

Describe Angle's appliance for retracting a cuspid. 

It consists in bands, carrying a tube, cemented to the molar and bi- 
cuspid. A threaded wire bent into a hook at one end passes through the 
tube and has a nut screwed on posterior to the end of the tube. The 
hook engages in a loop soldered on the palatal surface of a band around 
the cuspid tooth. 

Mention some of the evil effects of extraction for the purpose 
of regulating teeth. 

When all the teeth are in place and occlusion is normal, every cusp has 
a definite sulcus or interspace in which to rest. The extraction of any 
teeth to correct irregularity forever prevents the restoration of normal 
occlusion, and the cusps can never have restored to them their natural 
inclined planes. 

Describe the Jackson system of anchorage. 

It consists in a crib of wire heavily soldered on the lingual side and 
bent up and over interspaces between the occlusal surfaces, curving 
down and outlining the gingival line. 

Describe the Baker form of anchorage. 

The first molars of both jaws are banded to support labial arches which 
are fitted to conform to the labial surfaces of the teeth, resting particularly 
on the central incisors. Sheath hooks are attached to the upper arch at 
the points opposite the lateral incisors. The force is exerted by means of 
one or more small rubber bands, which engage the sheath hooks on the 



320 ORTHODONTIA 

upper expansion arch, and the distal ends of the sheaths of the anchor 
bands on the lower molars. It is used in the movement distally of the 
teeth of the upper, and mesially of those of the lower arch. With the 
sheath hooks placed on the lower arch, and the rubber bands stretched to 
the upper molar band-sheaths, the action is reversed. 

Describe a simple retainer for a single tooth that has been 
rotated. 

A band is fitted having a wire soldered across the lingual aspect the 
ends of which touch the lingual surfaces of the adjoining teeth on each 
side. 

Describe Dr. Case's retainer for the anterior teeth. 

Gold bands are fitted to each tooth and the series soldered together 
approximally, using an excess of solder. The labial portions of the bands 
are cut away, leaving the lingual portion and an X-shaped wedge fitting 
in the interdental spaces. The lingual surface is reinforced with a strip 
of gold plate. 

When force is exerted upon teeth to be moved, what change 
of tissue takes place? 

Gradual resorption of bone in advance of moving tooth and the for- 
mation of new bone in its wake. 

Mention some of the cells in the peridental membrane. What 
duties do they perform when teeth are moved in the treatment 
of malocclusion? 

Osteoclasts and osteoblasts. When a root is moved in the socket, 
the pressure stimulates the cells known as osteoclasts. The action of 
these cells is to break down and cause resorption of the bone in advance of 
the moving root. The stretching of the fibrous bands of the peridental 
membrane stimulates the osteoblasts to perform their function of throwing 
down new bone tissue in the wake of the moving root. 

Mention some of the precautions that should be taken to 
prevent decay of the teeth in applying bands and regulating 
appliances. 

The surfaces to be covered should be thoroughly cleansed, and the 
band or appliance must fit accurately and be cemented on. When cement 
has disentegrated the appliance should be removed and recemented. 
Perfect cleanliness of the mouth should be preserved while the appli- 
ances are being worn. 

What accidents may happen during the correction of dental 
irregularities? 

Strangulation of pulp at apical foramen followed by death of the organ. 
Severe pericementitis, injury to enamel, breaking of crown or root. 
Abrasion of gingiva. 

Describe Angle's method of treating a fractured maxilla or 
mandible. 

Angle's method in the great majority of cases is to band an upper 



ACQUIRED IRREGULARITY 321 

and lower tooth. Wire ligatures or short hook bars connect the bands 
holding the jaws in occlusion. In some cases teeth on each side of 
fracture are banded. These bands carry lugs over which are wound figure 
of eight ligatures of wire, or threaded bars are run through tubes on the 
band and tightened to close fracture. 

What results are liable to follow the premature extraction of 
the deciduous teeth? (a) Incisors, (b) Cuspids, (c) Molars? 

(a) Lip pressure causes a loss of the space occupied by the extracted 
deciduous incisor, and as a result the permanent incisor erupts labially 
or lingually to the normal, (b) Premature loss of cuspid and consequent 
loss of space will cause the permanent cuspid to erupt labially, sometimes 
forcing the lateral inside of arch. Sometimes absolute impaction of 
the canine occurs, (c) Loss of molar prevents the wedging caused in the 
eruption of the permanent molars and consequent shortening of the arch, 
causing either impaction of bicuspids or malocclusion of the entire arch 
on that side. 

How would you locate an unerupted tooth? 

In simple cases a probe is sufficient; otherwise by means of the X-ray. 
A radiograph will show the position of the unerupted tooth and its relation 
with the surrounding structures. 

Name two typical cases of acquired irregularity. Describe 
your treatment. 

1. Protrusion of superior incisors. 

2. Eruption of superior cuspid labially and above the line of normal 
occlusion. 

1. The central incisors, first bicuspids and second molars are banded. 
Lingual bars are soldered from molar bands to biscupid bands on each 
side of the mouth and notched lugs soldered to the labial surfaces of in- 
cisor bands. An expansion arch is adjusted, sliding in tubes soldered to 
the buccal surfaces of molar bands, and fitting in the notched lugs on 
incisor bands. The first bicuspids are ligated to a sliding collar on the 
expansion arch. Rubber bands are stretched from a hook on arch 
opposite first biscupid over the tube on molar band. The action of this 
appliance is to spread the arch, giving space for the incisors, which are 
moved back into position by the pressure of the expansion arch, pres- 
sure being secured by the rubber bands on each side. 

2. The lower second bicuspid is banded, a lug being soldered on the 
labial side of the band. A small hole is drilled in the labial surface of 
the superior cuspid and a gold screw inserted. Rubber bands are 
stretched from screw to lug. The steady traction of the rubber draws 
the cuspid down and back into proper occlusion. Normal occlusion on 
the bicuspid prevents its rising to meet the cuspid. In each case after 
proper occlusion is attained, retaining appliances should be worn until 
the tissues have become permanently fixed in their changed relations. 



OPERATIVE DENTISTRY 



What instruments should receive special attention as regards 
sterilizing? What means should be employed to effect thorough 
sterilization? 

All instruments, but especially those used in the treatment of root 
canals, for cutting or penetrating the soft tissues, or those used on patients 
afflicted with infectious diseases. 

Boiling for five minutes in water containing sodium bicarbonate is 
possibly the best means of sterilization, although subjection to the action 
of formaldehyd for ten or fifteen minutes has less harmful effect on the 
instruments. 

What is the objection to the use of bichlorid of mercury for 
sterilizing instruments? 

It has a corroding effect on the instruments, harmful to the keen cutting 
edges. 

Describe a method of sterilizing excavators without injuring 
them. 

After washing with soap and water, dry and subject them to the action 
of formaldehyd gas in a closed container for fifteen minutes. 

Mention the benefit derived from the use of electricity in 
dental practice. 

The operation of numerous appliances, such as the engine, porcelain 
furnace, laboratory lathe, electric mouth lamp, antrum lamp, gold an- 
nealer, root canal dryer, sterilizer, water heater, etc., etc. Cataphoresis 
is still sometimes used. The X-ray is also of inestimable benefit to the 
dentist. 

When are artificial crowns and bridges indicated and when 
not? 

When through decay or accident insufficient tooth substance remains 
to support a filling, a crown is indicated. It is counter-indicated if a 
filling is possible, or the root or membrane incurably diseased. Bridges 
are indicated when there is a break in the dental arch and a sufficient 
number of strong teeth or roots are in place for anchorage. When 
teeth or roots are diseased and incapable of standing the stress, or when 
great absorption has taken place, a bridge is counter-indicated. 

Describe the method of examining the teeth of patients and 
mention the instruments used. 

The necessary instruments are: Mouth mirrors, explorers, silk 
ligatures, wedges and napkins. It is well to have the teeth clean before 

322 



MKTHOD or CLEANSING CHE TEETH 323 

making an examination. In examining have a system. Begin at the 
median line and examine all surfaces of each tooth in succession with 
explorers, testing the approximal surfaces with silk ligatures. An elec- 
tric mouth lamp is a great aid in discovering decayed areas on approx- 
imal surfaces. 

What treatment should the oral cavity receive preliminary to 
operating? 

All deposits on the teeth should be removed, the tissues sprayed 
with hydrogen peroxid, and the mouth rinsed with an antiseptic wash. 

Give the etiology, prognosis and treatment of inflammation 
of the membranes of the mouth preparatory to operations on the 
teeth. 

Lack of cleanliness, salivary calculus, ragged edges of cavities, broken 
down teeth and roots, and constitutional causes such as syphilis, phos- 
phorus poisoning, combine to produce inflammatory conditions of the 
membranes. 

Prognosis: Return to normal condition after proper treatment, 
which consists in removing all salivary calculi, loose roots and rough 
edges, followed by thorough polishing of the teeth. A mild alkaline 
wash should be ordered. Inflammation or diseased conditions due to 
systemic causes should receive constitutional treatment 

Describe the method of cleansing the teeth. 

First spray the teeth and gums with hydrogen peroxid and rinse the 
mouth with an antiseptic, astringent wash. Remove all deposits with 
suitable scalers and polish with pumice powder carried on rapidly re- 
volving rubber cups, brushes and wood points. Follow the pumice with 
finely powdered chalk on revolving brushes. Paint gums with dilute 
iodin and rinse with mild antiseptic wash. 

How should a first permanent molar with inflamed pulp be 
treated in a child seven years of age? 

If inflammation is not great and has not been present for long, the pulp 
should, if possible, be saved until the development of the roots is com- 
pleted. If the inflammation has been great or there has been much 
bacterial infection, the pulp should be devitalized and removed. Fill 
canal with guttapercha and cavity with amalgam. 

Give the treatment of exposed pulp in deciduous tooth of a 
child of six. Give reasons. 

Devitalize with equal parts of sulfate and acetate of morphin rubbed 
into a paste with carbolic acid. Remove pulp and control hemorrhage 
from apical foramen. Heat parafnne until soft, and incorporate iodoform. 
Fill canals with the warm paraffine and the cavity with guttapercha. 
This treatment favors normal absorption of the roots with a correspond- 
ing absorption of the root filling, offering no impediment to the erupting 
permanent tooth. Capping of a deciduous pulp is rarely satisfactory. 



324 OPERATIVE DENTISTRY 

Briefly describe the treatment for a patient six years old 
having simple cavities in the anterior teeth with pulp exposed 
and aching in first molar. 

Although at six years of age the anterior deciduous teeth are about to 
be lost, the cavities should be excavated and filled with white guttapercha. 
The treatment for the first molar is outlined above. 

How should the canals of deciduous teeth be filled? 

See answer to preceding question. 

What are the best filling materials for deciduous teeth? 

Oxyphosphate, copper cement, guttapercha, amalgam. 

Give the treatment of a child of ten whose central incisors 
are broken so that the pulps are exposed. 

The teeth should be protected from moisture. A saturated solution 
of cocain in chloroform is then applied to the pulps and allowed to 
remain until anesthesia is established. Pressure with unvulcanized 
rubber will hasten the action after the exposed part is anesthetized. 
Remove pulps, wipe out canals with carbolic acid, dry and fill with 
guttapercha covered with gold foil. When the tooth is fully erupted, the 
broken portions can be restored with porcelain or the remaining por- 
tions of crowns ground off, and porcelain crowns adjusted. 

Describe a method of treating decay in deciduous teeth. 

As much of the decay as possible should be removed with spoon- 
shaped excavators. A pledget of asbestos fiber, saturated with nitrate 
of silver, is placed in cavity for a few seconds, then removed, the cavity 
dried out and filled with copper cement or guttapercha. 

State the uses of nitrate of silver in operative dentistry. 

It is used as a cauterizing agent, to sterilize decayed tissue in decidu- 
ous teeth, and to obtund sensitiveness around the necks of teeth and 
under clasps. 

Why does the application of nitrate of silver arrest decay in 
teeth? 

It destroys the bacteria present and forms with the albumen of the 
dental tubules albuminate of silver, which is impenetrable to further 
decay. 

Mention treatment of defective rough condition of sulci in 
children's teeth before softening occurs. 

The roughness should be polished smooth with sand paper disks, 
and the surface touched with a solution of silver nitrate. 

How should an abscessed deciduous tooth be treated? 

Evacuate pus by lancing. Open pulp chamber, clean cavity and 
canals. Pump carbolic acid and iodin through canal and out through 
fistula. Fill canals and chambers temporarily with cotton saturated with 
camphophenique. Fill cavity with temporary stopping. Repeat treat- 
ment until tissues return to normal. 



GREEN STAIN 325 

Give the treatment in case of pulp exposure attended with 
pain in a deciduous tooth. 

First relieve pain and reduce inflammation with one of the essential 
oils. Then devitalize with arsenical fiber or carbolic acid. 

Under what conditions in deciduous dentition is gum lancing 
indicated? Explain. 

The downward pressure of the gum on the occlusal surface of the 
erupting tooth causes pressure of the rough edges of the partly formed 
root on the underlying nerves and the remains of the dental papilla:. 
This causes direct irritation and reflex nervous condition. The child 
becomes irritable, the stomach refuses to functionate properly. There 
is diarrhea, sometimes alternating with constipation, possibly convulsions. 
When these symptoms are present, the gums should be lanced over the 
teeth next to be erupted. 

In doubtful cases, how would you distinguish a temporary 
from a permanent tooth? 

Taking into consideration the age of the patient, by the relative size 
of the tooth, narrowness of neck of the tooth, difference of color, and flat- 
ness of cusps. 

Give directions for the general care of the mouth and teeth 
of children. 

The child should be instructed in the use of tooth brush and dental 
floss. The floss should be used after each meal, followed by the brush 
dipped in a mild antiseptic wash. The brush should also be used the 
last thing before retiring, carrying a good powder or paste to all surfaces 
of the teeth, brushing thoroughly in the direction of the long axis of the 
teeth. Frequent examination and polishing by the dentist are advised. 

Describe the treatment of deciduous teeth that will insure 
health of the oral cavity and regularity of the permanent teeth. 

The child should be instructed in the systematic use of the tooth 
brush from the first. Regular and frequent visits should be made to the 
dentist for examination. The operator should keep the teeth polished 
and free from stains. Cavities should be excavated and rilled, and every 
effort made to preserve the teeth until the physiological time for the 
eruption of the permanent teeth. 

Give etiology and treatment of green stain on children's 
teeth. 

It is a bacterial growth (leptothrix buccalis). The treatment con- 
sists in staining the growth with tincture of iodin. Allow this to remain 
for several minutes, then polish off with pumice and an orange wood 
stick. The enamel will be found slightly softened under green stain, 
and thorough polishing with pumice in a rapidly revolving rubber cup is 
indicated to restore the surface. 

What injury may result from green stain on children's teeth? 

Decomposition of underlying enamel, probably due to acid waste 
products of the bacteria. 



326 OPERATIVE DENTISTRY 

What is erosion? Give cause and treatment. 

It is the action of an acid secretion on the surface of the teeth, attacking 
principally the cervical third of the labial surface and producing a cup- 
like appearance An antacid mouth-wash, such as milk of magnesia, 
upon retiring. If concavities are deep, they may be filled with gold 
or porcelain. 

Define abrasion. State causes and give method of restoration. 

It is the excessive wearing down of the occlusal surfaces of the teeth, 
and is usually accompanied and greatly assisted by acid disintegration. 
Restoration is produced with gold caps and gold or porcelain tips. 

Give the cause and treatment of pits on the labial surface of 
teeth near the incisal edge. 

Caused by the arrest of development in the enamel organ, usually 
at a time of some eruptive fever. If not too deep, they may be ground 
out with corundum or sand paper. When deep, they should be enlarged 
and filled with cement, porcelain or gold. 

What is hypersensitive dentin? Give treatment. 

Abnormally sensitive condition of the pulp prolongations in the 
tubules of the dentin, being most acute at the junction of the dentin and 
enamel. The sensation is minimized if the cavity is dried, wiped with 
carbolic acid, dried again with hot air, and Robinson's remedy applied 
for a few minutes. 

State the most efficient and satisfactory treatment of teeth 
that have become sensitive with a tendency to decay under 
plate=clasps. 

Any distintegrated enamel should be ground off and the surface 
polished, after which the sensitive part should be bathed or painted with 
dilute silver nitrate. The silver nitrate application should be repeated 
until sensation returns to normal. 

Describe the treatment of a tooth that is extremely sensitive 
to thermal changes after filling. 

The filling should be removed and cavity treated with carbolic acid, 
lined with cavatine, and a guttapercha filling inserted till all inflamma- 
tion has subsided, when a permanent filling may be inserted. 

Describe the treatment of anterior teeth that are sensitive at 
the gingival border. 

This condition is relieved by painting the neck of the affected teeth 
with zinc chlorid (repeat). Order alkaline wash, such as milk of mag- 
nesia, to be used upon retiring. 

State the action on the dentin of remedies used to obtund 
sensitivity. Name three efficient remedies and give the technic 
of their use. 

These remedies either destroy the fibrillar in the dental tubules or 
render them incapable of transmitting sensation to the pulp. 



1 lURNAi'IOX 327 

Alcohol (95 per cent.) placed in cavity, followed by a stream of hot 
air, desensitizes by depriving the librilke of their moisture. 

Carbolic acid. A crystal is placed in cavity, melted, and the cavity 
desiccated with a stream of hot air. Escharotic destruction of dental 
fibrilke. 

Zinc chlorid. Technic as for carbolic acid. It penetrates tubules 
chemically, changing contents and forming an impenetrable compound. 
There is, however, an element of danger in the latter. Pulp destruction 
may result from the use of too great a quantity. 

What causes the deposit over an exposed pulp? 

Stimulation of the pulp to its formative function. 

Give diagnosis of exostosis. State the cause and treatment. 

Dull pain caused by pressure and irritation, both at point of exostosis 
and reflected to other parts. Hard, dense swelling is frequently noticeable, 
The above conditions existing, tooth normal to thermal test and no pro- 
nounced inflammation of gum tissue or soreness upon percussion, the 
diagnosis of exostosis would be reasonable. The cause is prolonged 
irritation of the periosteum. If the cause of irritation can be removed, 
the tumor will cease to enlarge; if not, extraction is indicated. 

What is meant by '^bui-nation?" 

It is the replacing of the contents of the dentinal tubule with calcine 
deposits. 

Is the deposit of secondary dentin physiologic or pathologic? 

Physiologic. It is the natural way for the pulp to protect itself when 
overstimulated. 

Why does the contact of fillings of different metals result 
in shock to the teeth? 

The action of acid in the saliva on two metals of different polarity 
causes a galvanic electrical current to pass from the metal to the pulp. 

(a) What is the thermal test? (b) How is it conducted? 
(c) For what purpose is it useful? 

(a) The application of heat and cold to a tooth to determine the con- 
dition of the pulp, (b) The tooth is isolated with rubber dam and hot 
water, or cold water applied on cotton, or by means of syringe, (c) To 
diagnose a putrescent pulp in a sound tooth: pain increases with heat on 
account of gas expansion. To diagnose inflammation of the pulp: pain 
increases with heat, due to further engorgement of blood, and lessens 
with cold. To differentiate vital and pulpless teeth. 

Why are teeth recently filled more liable to shock from 
thermal changes than other teeth? Give preventive treatment. 

On account of the greater conductivity of the filling material. Metals, 
especially, rapidly conduct heat and cold to the underlying sensitive 
dentin, and sometimes close to the pulp itself. This condition may be 
prevented by lining the cavity with a non-conducting material, such as 
cavatine. 



328 OPERATIVE DENTISTRY 

What classes of operations tend to induce a pathological 
condition of the pulp and membranes of the teeth? 

The practice of orthodontia, if too rapidly performed, prolonged 
grinding, too rapid separating, the placing of metal into too close proxim- 
ity to the pulp, and over-malleting of gold, all tend to cause a pathological 
condition of the pulp. The above causes, both directly and indirectly 
excessive sealing and polishing of the teeth, improperly finished gingival 
margins of filling, especially amalgam, and excessive counter-irritation, 
cause pathological conditions of the membrane. Careless extraction and 
the use of local anesthetics are also responsible for such conditions. 

How would you diagnose a diseased pulp in an apparently 
sound tooth? 

By means of the thermal test. 

Describe the diagnostic signs of a dead pulp in a tooth when 
there is no pulp exposure. 

The tooth loses its translucency and gradually becomes yellowish, 
sometimes almost dark. There is no response to the thermal test, but 
frequently sensitiveness on percussion. 

In a case of manipulated exposure of an infected pulp, with 
no previous exposure from cavity of decay, what preliminary 
treatment would be advisable? 

Disinfection of the pulp by means of campho-phenique sealed in for 
a few days or repeated until infection is overcome, when capping is indi- 
cated. (It seems impossible that such a pulp should become infected 
except through accident or carelessness on the part of the operator.) 

What symptoms would counterindicate the capping of a pulp? 

Congestion causing odontalgia. Extreme sensitiveness; evidences of 
bacterial infection of the pulp. 

When should a pulp be capped and why? 

When it has been accidentally exposed during excavation and no 
bacterial infection has taken place. The capping is to preserve it in its 
natural vital state, maintaining the color and translucency of the tooth. 
If possible, the pulps of deciduous teeth should be preserved to insure 
proper absorption of the root and exfoliation at the proper time. 

Describe minutely your method of capping a pulp. 

After protecting from moisture by the rubber dam, the cavity is care- 
fully excavated and shaped. A paste consisting of oil of cloves, carbolic 
acid and oxid of zinc, is allowed to flow over the exposure and covered with 
a concavo-convex disk of block tin, larger than the exposure. A thin 
layer of cement is flowed over the tin disk, and a temporary filling inserted 
until all symptoms of inflammation have disappeared. 

What are pulp stones? Give treatment. 

Pulp stones are calcified deposits in the pulp tissue caused by protracted 
irritation. The treatment consists in anesthetizing or devitalizing, and 
removing the entire pulp. 



PULPITIS 329 

Give diagnosis of irritation from pulp stones. 

The pain is seldom very acute, but dull and neuralgic in character, 
frequently being reflected to the face and head. Pain in a sound tooth of 
a dense character would suggest pulp stone. 

What is odontalgia? Of what is it a symptom? 

It is pain in a tooth and is a symptom of irritated or inflamed pulp 
tissue. 

What method should be employed to distinguish and locate 
odontalgia from idiopathic neuralgia? 

By the thermal test or by percussion. 

What is pulpitis? Give etiology and symptoms. 

Inflammation of the pulp. Caused by thermal shock, blow, infection 
by bacteria. Odontalgia, increased and decreased by heat and cold 
respectively. 

How may irritation of the dental pulp be determined and 
located when there is no pulp exposure? 

By the thermal test and percussion. 

Give treatment in case of pulpitis. 

In a sound tooth the inflammation may be relieved by counter-irrita- 
tion over the apex of the root. Where there is exposure of the pulp, a 
sedative is sealed in until inflammation has subsided, when the pulp is 
devitalized and removed. 

How should a freshly exposed pulp be treated? 

The pulp may be capped by melting crystals of thymol over exposure, 
followed by oxychlorid of zinc and a temporary filling. 

Describe the method of treatment in painful pulp exposure. 

A solution containing chloretone or oil of cloves is sealed in until the 
pulp returns to normal, when it is devitalized or anesthetized, and 
removed. 

Give treatment of inflammation of the pulp in a superior 
central incisor that has a gold filling in good condition in 
approximal surface. 

Open the pulp chamber from the basilar pit on the palatal surface. 
Bleed pulp to relieve congestion and extirpate under cocain 

When the pulp of a tooth has sloughed, having discharged 
through a cavity, how should it be treated and filled? 

A 2 per cent, solution of formalin should be sealed in the canal and, 
at a subsequent sitting, the canal reamed with a Gates Glidden drill. 
An antiseptic dressing, such as eugenol or carbolic acid and iodoform, 
is sealed in the canal for a few days, when the canal can be permanently 
filled with oxychlorid of zinc or guttapercha, and a temporary filling 
inserted. If no pericementitis results in a week or ten days, the cavity 
may be permanently filled. 



330 OPERATIVE DENTISTRY 

When shall a pulp be devitalized? 

When exposed by the inroads of decay. After severe inflammation 
from shock, pulp stones or other causes, and when the grinding for 
crown leaves but a thin covering for the pulp. Where the use of the canal 
is demanded for anchorage. 

What are the risks attending the devitalization of pulps by 
arsenic? 

The risk of increasing the inflammation of the pulp, of causing a 
necrotic condition of the contiguous gum tissue, and of apical pericemen- 
titis when the arsenic is allowed to remain in the tooth too long. 

Give a safe and reliable way of applying arsenic for the 
devitalization of pulp. 

The rubber dam should be adjusted and carried well beyond, to 
margins of cavity. Cavity excavated and a paste consisting of arsenious 
acid, carbolic acid, and iodoform, placed in the cavity on a small pledget 
of asbestos fiber. A concave disk placed over exposure and paste. The 
cavity filled with temporary stopping or oxychlorid of zinc. 

How should a pulp be devitalized by arsenic when decay 
exists below the soft tissue? 

The cavity should be excavated and the gingiva protected with 
temporary stopping, cavity dried, arsenic placed over exposure, concave 
metal cap over arsenic, and the remainder of the cavity filled with tem- 
porary stopping. 

What are the symptoms of arsenic poisoning of the gum 
tissue? 

The gum becomes dark and leathery. Sloughing takes place, and the 
tooth becomes sensitive on percussion. 

Give a method of removing pulps other than by devitalization. 

The pulp may be anesthetized by means of cocain and removed 
with a clean, barbed broach. The cocain crystals are dissolved in a 
minute amount of chloroform or formalin, and introduced into the cavity 
on a small pledget of cotton; the cavity is then filled with unvulcanized 
rubber. Gradual pressure made with a ball burnisher forces the cocain 
into the pulp. 

How should a pulp canal be prepared for filling? 

All pulp tissue should be removed, the canals enlarged with a flexible 
reamer, sterilized, flooded with absolute alcohol, and dried with a hot wire 
or hot air. 

How should a root canal be treated and filled after a pulp 
has been removed under pressure anesthesia? 

After hemorrhage has ceased, wash with warm sterile water, dry 
with cotton on broach, flood canal with absolute alcohol, and dry with 
a stream of hot air, followed with canal drier. Fill with a thin paste 
of oxychlorid of zinc cement. 



TREATMENT OF ROOT CANALS 33 1 

(a) What material is preferred for root canal filling? (b) 
Justify your choice and give technic of insertion of the filling. 

(a) For lower teeth and upper anterior teeth, oxychlorid of zinc 
cement; for upper posterior teeth, oxychlorid of zinc cement and gutta- 
percha point. 

After being cleaned, enlarged and sterilized, the canal is moistened 
with absolute alcohol and dried with hot air or canal drier. The 
tooth is protected from moisture. The oxychlorid is mixed thin enough 
to drop from spatula, introduced into the canal on a fine tooth broach 
and, with a pumping motion, is forced to the apical end of the canal. In 
place of the oxychlorid solution, euchapercha or chlorapercha, in con- 
junction with guttapercha points, may be used. 

The technic for the upper posterior teeth is the same, with the addi- 
tion of a fine guttapercha point being forced into the cement while soft. 
This is done because in the upper teeth we have the force of gravity to 
overcome, and the addition of the guttapercha assures absolute filling 
of the entire canal. 

(b) The advantages of oxychlorid of zinc are : Ease of manipulation, 
positiveness of results, insolubility when in canal, and non-shrinking 
qualities. It also has the effect of penetrating the dental tubuli, steriliz- 
ing them and rendering them impenetrable, thereby better preserving 
the color of the teeth. 

How should crooked buccal root canals be treated and 
filled? 

The canal should be enlarged with sulfuric acid and a flexible 
reamer, and oxychlorid of zinc pumped to, or nearly to the foramen. 
The pulp chamber should now be filled with soft guttapercha and com- 
pressed with a ball burnisher, which will force the oxychlorid to the 
end of the canal. 

Describe a method of filling a root canal having a large 
apical foramen. 

The canal is wiped out with oil of eucalyptus, and a guttapercha 
point inserted until patient complains of sensation, removed and the 
end cut off. This process is repeated until there is no further sensa- 
tion, when the point is allowed to remain, and the cavity end sealed with 
a hot burnisher. 

Give a method of removing a pulp and filling the root canals 
in inferior molars with approximal cavities in distal surfaces. 

The distal cavity is prepared and filled, and a new opening made 
through the occlusal surface. This conserves tooth tissue and gives 
ease of access. The canal should be reamed, sterilized, and oxychlorid 
of zinc pumped in with a smooth broach. 

Under what condition is immediate root canal filling 
advisable? 

When there has been little or no bacterial invasion, and the pulp 
has been removed under cocain anesthesia. 



332 OPERATIVE DENTISTRY 

What is mummification of the dental pulp? State under 
what conditions such treatment would be advisable. 

The process of placing a material against the pulp to cause desicca- 
tion and permanent resistance to putrefactive processes. Alum in 
combination with antiseptics is used. It is indicated only where inaccessi- 
bility of the pulp or canals makes removal of the pulp tissue impossible. 

Describe a method of treating a perforated root where the 
gum has grown through the opening, filling the pulp chamber 
and resembling a fungoid pulp. 

The gum tissue is excised under a local anesthetic, such as cocain and 
adrenalin injection, or ethyl chlorid spray. The hemorrhage is checked, 
and pledgets moistened with iodin packed in canal perforation. At a 
later sitting the cotton is removed, the perforation covered with platinum 
foil, held in place with chloro-percha, and the canal rilled with thin cement. 

What diseases may arise from a putrescent pulp? 

Pericementitis and alveolar abscess. 

What causes pericementitis? 

Any direct source of irritation, such as serumal or salivary calculus, 
the rapid moving of a tooth in orthodontia, malocclusion from a filling 
left too high, pressure of gas from a putrescent pulp, and arsenical pois- 
oning. Indirectly an inflamed pulp and the use of drugs such as mer- 
cury or potassium. 

What characteristic pain results from a pathological condi- 
tion of the peridental membrane? 

Dull steady pain; a feeling of elongation. Light pressure produces 
more pain, heavy pressure relieves pain. 

What are the distinguishing symptoms of pericemental and 
pulp pain? 

Pericemental: Dull and steady, increased by light pressure. 
Pulp: Sharp and throbbing, usually unaffected by pressure. 

Give treatment for pericementitis. 

Remove the cause. If dead or putrescent pulp, open canal, clean 
carefully with broach, sterilize with formalin, and ream. Seal in treat- 
ment of camphophenique and apply counter-irritation to the surface 
of the gum tissue. Pericementitis following arsenical treatment or after 
root-filling usually responds to counter-irritation. 

Give the diagnosis of pericemental abscess. State the 
treatment employed and the medicaments used. 

Dull pain, tooth, slightly raised in socket, gum swollen. Pressure 
on tooth gives relief, on gum increases pain. Apply counter-irritant 
at some spot near, but not over the affected spot. Pass thin lance or 
probe along root and evacuate pus. Cotton wound on a probe and wet 
with hydrogen peroxid is passed into abscess until ebullition ceases, 
when carbolic acid and iodin or chlorid of zinc is substituted. 



blind ABSCESS 333 

How should alveolar abscess be treated? 

In the first stage the abscess may be aborted, or its progress hastened. 
It may sometimes be aborted by means of counter-irritation, cold appli- 
cations, and the free opening of the pulp canal, followed by a dressing of 
carbolic acid and iodin in the canal. If too advanced to be aborted, 
hot applications on the gum over the affected root will hasten the course of 
the pus through the alveolus, and then the gum may be lanced and the 
pus evacuated. The canal should be reamed, and carbolic acid and iodin 
pumped, by means of a broach wrapped with cotton, into the canal 
and out through the fistula. The canal must be left open until the 
irritation has subsided, usually twenty-four hours, after which carbolic 
acid and iodin or camphophenique is sealed in and changed frequently 
until the tissues have returned to normal. If a chronic abscess fails 
to respond to the foregoing treatment, amputation of the root end is 
indicated. 



What is a blind abscess? 

An abscess, usually chronic, having no fistula, is commonly called 
blind. 

What is the treatment of an alveolar abscess without fistula 
when roots have been properly treated and filled? 

An opening is made through the gum and alveolar plate, with a 
spear-head drill, to the end of affected root, evacuating the pus. A 
rose-head burr may then be used to smooth off the root. The abscess 
cavity is then washed w T ith hydrogen peroxid, followed by carbolic acid 
and iodin. 

Give the treatment of a tooth with a putrescent pulp when 
there is free discharge from the pulp through an occlusal 
cavity. 

The cavity should be thoroughly evacuated, and the mouth of the 
canal opened wide. A smooth broach is dipped in a mixture of sodium 
and potassium and worked up into the canal. Ebullition takes place. 
The sodium and potassium convert the oils and fats into soap, which is 
easily washed out with a stream of hot distilled water. A dressing of 
carbolic acid and iodin is now sealed in for a few days, when, if no putres- 
cence exists, the canal is permanently filled. 



Give the treatment of chronic blind abscess affecting the 
lower teeth. 

Enlarge canal and apical foramen with flexible drill to evacuate pus. 
Pump carbolic acid and iodin through apical foramen and seal in dressing 
of camphophenique. Repeat until the condition is corrected. In 
obstinate cases it is well to run drill through apical foramen and break 
up abscess sac. 



334 OPERATIVE DENTISTRY 

What is root amputation? Describe the operation. 

The removal of the end of a root. The field and instruments being 
rendered aseptic, an incision is made over affected root, and the alveolar 
plate penetrated with a large rose head burr. Control hemorrhage with 
tannic acid. With a small, thin fissure burr the root is amputated at the 
point where the periosteum has been detached. The excised portion is 
now removed, and the stump smoothed with a hoe shaped sealer. The 
wound should be packed with iodoform gauze and allowed to heal by 
granulation from within out. 

Why do pulpless teeth lose their natural hue? 

Because of the death and consequent loss of the dental fibrillar and 
the infiltration of pigments from the disorganized pulp. 

What causes the pink color sometimes found in teeth? 

Infiltration with hemoglobin, the color element of the blood. This 
generally follows the sudden death of the pulp from a blow or by strangu- 
lation. 

What causes pulpless teeth to blacken? 

Hemoglobin decomposes and infiltrates the dentinal tubules. Putre- 
faction decomposes sulfur with end products of hydrogen sulfid in con- 
tact with albumin. Sulfur compounds are formed with hemoglobin, 
resulting in a bluish-black stain. 

Give a method of bleaching teeth. 

The chlorin method. The tooth is isolated with rubber dam and 
securely ligatured at the neck. All metallic fillings are removed, and the 
upper third of canal packed with guttapercha. Calcium hypochlorite 
is packed into canal, pulp chamber, and cavity with wooden instruments, 
and moistened with acetic acid. Chlorin is evolved, which combines 
chemically with the staining agent and changes its chemical composition. 
The tooth is now thoroughly irrigated with hot distilled water and filled 
temporarily with white guttapercha. 

Give the etiology of gingivitis. Mention the operation and 
the remedies necessary to relieve this condition. 

Gingivitis may result from mechanical, chemical or medicinal irrita- 
tion, or may be part of a constitutional disorder. The treatment for the 
atter would be to correct the disorder and treat the gums locally with a mild 
astringent wash. In all cases the irritant should be removed and a wash 
of dilute phenol sodique ordered. The gums may be painted with a 
weak tincture of iodin. If the medicinal irritant is arsenic, the affected 
tissue should be bathed with freshly prepared sesquioxid of iron. 

State the importance of removing deposits from the crowns 
and necks of teeth. 

Salivary calculus, if allowed to accumulate, encroaches on the gum 
and finally on the pericementum, causing inflammatory conditions and the 
recession of the soft tissues. In time the teeth may be forced out of 
position. 



PYORRHEA ALVEOLARIS 335 

Describe methods of removing these deposits and give the 
subsequent treatment. 

Spray gums with hydrogen dioxid and wash out mouth with a 
weak solution of phenol sodique. Remove deposits with appropriately 
shaped scalers and thin chisels; the scalers should cut with a drawing mo- 
tion. They are inserted under the deposit at the gum margin and drawn 
toward the cutting edge of the tooth. The chisels are used with a pushing 
motion between the teeth. The teeth should now be thoroughly polished 
with pumice moistened with glycerin, and carried on rapidly revolving 
rubber cups, brushes, and wooden points. A final polish with prepared 
chalk is advisable. The gums should be painted with camphophenique 
and an antiseptic wash ordered. 



In the treatment of pyorrhea alveolaris, what attention 
should be given the patient's diet? 

Eliminate alcoholic beverages, avoid highly seasoned food, sugars, 
and acids. 



Pyorrhea alveolaris is sometimes the local manifestation of 
which nutritional disorders? 

It is commonly the local manifestation of disorders of elimination of 
waste products, being present in patients suffering with gout, rheuma- 
tism, faulty digestion, and those of a uric acid diathesis. 



Differentiate pyorrhea alveolaris and salivary calculus. 
Give the cause, prognosis and treatment of each. 

Salivary calculus (tartar) is a deposit on the crowns and necks of the 
teeth composed of lime salts from the saliva and the dried remains of food 
substances. The treatment is given in answer to a preceding question 
(see page 335). Pyorrhea alveolaris is suppuration in the alveolar process 
surrounding the roots of the teeth. The infection is favored by the irri- 
tation of tartar on the roots of the teeth under the pericementum. Prog- 
nosis is favorable except where the loss of pericementum is very great or 
the patient is advanced in years. 

The treatment is given on page 305. 

Differentiate implantation, replantation, and transplantation. 

Implantation is the operation of opening the tissue, forming a socket 
in the alveolar process, and inserting a suitable tooth. Replantation is 
the extracting of a tooth, treating it antiseptically, filling its canals, and 
replacing it in the socket from w r hich it has been extracted. Teeth lost 
through accident may be treated in this manner. Transplantation of a 
tooth is the extraction of a tooth from the jaw of one individual and its 
insertion into the socket left by the extraction of a similar tooth or root 
in the jaw of another individual. 



336 OPERATIVE DENTISTRY 

Describe the process of replanting teeth and state precautions 
necessary. 

The tooth is extracted under aseptic conditions and placed in an 
antiseptic bath, preferably 5 per cent, lysol. The socket is packed 
with gauze soaked in camphophenique. The tooth is now dried 
and the canal reamed, enlarging the apical foramen. The canal is 
filled with cement, and the cavity with gold foil. The cement at the 
apical foramen is now burred out for a short distance, the canal undercut, 
and a small gold filling inserted and highly polished. The tooth is 
returned to its antiseptic bath for at least one hour. The gauze is now 
removed from socket, and the tooth replaced in position and ligatured 
with gold wire to the adjoining teeth for ten days or two weeks, during 
which time an antiseptic mouth-wash should be frequently used. The 
use of bichlorid of mercury, as recommended by some operators, is too 
irritating to the tissues, being absorbed by the tooth and given off con- 
tinuously for some time after the tooth has been returned to its socket. 

Describe the operation of implanting and precautions 
necessary. 

A tooth of the proper size having been selected, the canal is reamed 
from the apical end and filled with guttapercha to within a short distance 
of the end, finishing with gold foil. The gold is highly polished, and the 
tooth placed in a bath of 5 per cent, lysol. The gum tissue is now freed 
from mucus and sterilized with lysol. Either with or without a local 
anesthetic, a curved incision is made in the gum and the bone exposed. 
A spear-shaped drill running at high speed is carried to the depth of the 
proposed socket, and the opening enlarged with an osteotome. The 
tooth is now tried in the socket, removed and the socket deepened or 
widened until a snug fit is secured. The socket is thoroughly washed with 
lysol, the tooth placed in position, and ligatured with gold or brass wire 
to the adjoining teeth for ten days or two weeks, an antiseptic mouth- 
wash being imperative during this period. Care must be exercised to 
sterilize the tooth for at least one hour, not to injure blood-vessels or 
nerves, or ream the socket too deep, nor to render the labial plate of 
the alveolars too thin. In bicuspid and molar implantation there is danger 
of penetrating the antrum of Highmore. 

What is dental caries? 

Disintegration of the tooth tissue caused by acid and bacterial action 

How is dental caries classified? 

Dental caries may be classified as superficial, deep seated, simple, 
complicated, rapid, and slow. 

What is superficial dental caries? Give treatment. 

Dental caries in its first stage, before the dentin is reached, is called 
superficial dental caries. 

The treatment is either to polish out with disks, strips, or stones; or 
cut out deeper and fill. 



DENIAL CARIES 337 

What is deep=seated dental caries? Give treatment. 

Caries in which the disintegration has progressed far into the dentin 
is called deep-seated dental caries. 

Treatment: Excavate all decayed tissue. Wipe with carbolic acid. 
Coat the wall over the pulp wth cavitin or chlorapercha and fill. 

Give etiology and general preventive treatment of dental 
caries. 

Dental caries is caused by fermentation of food particles forming 
lactic acid, which disintegrates the enamel and is followed by bacterial 
invasion, and breaking down of the dentin. Prevention consists in 
thorough cleansing with tooth brush, a good powder or paste, and dental 
floss used several times daily. 

Mention the form and advantage of excavator points for 
removing deep=seated decay in teeth. 

Spoon shaped excavators conform to the shape of the cavity, lifting 
the decay in layers. They are less likely to expose the pulp or cut deeper 
than required. 

What form of burrs is preferable for removing deep=seated 
decay? Give reasons for using this form of burr and state 
method of use. 

The round form more nearly conforms to the natural shape of a 
cavity and is less likely to expose the pulp. It covers a greater surface. 
In a rapidly revolving hand-piece, lifted frequently from the work, the 
pain due to heat is minimized. 

What form of burr should be used (a) for opening and 
following the course of sulci; (b) for forming the floor of a 
cavity for a gold filling? 

(a) A fissure burr, (b) An inverted cone burr. 

What instruments should be used to smooth or finish cavity 
margins? 

Chisels, hoe excavators, stone disks, strips and burrs. 

How should teeth be separated for the purpose of inserting a 
filling? 

Either by a mechanical separator, or by the gradual action of rubber, 
linen tape, cotton, or orange wood. 

How should teeth that have been wedged be guarded against 
injury during filling? 

They should be firmly wedged with orange wood or supported with 
modelling compound or cement. 

By what means can cavities be protected from moisture 
without recourse to the rubber dam? 

By means of linen napkins, cotton rolls, saliva ejector, and Japanese 
crepe paper. 



338 OPERATIVE DENTISTRY 

State in what class of cavities and under what conditions a 
matrix is essential. 

In compound cavities involving to any extent the approximating 
surface in bicuspids and molars. When amalgam is employed in this 
kind of cavity, the matrix is imperative to enable the operator to condense 
the amalgam and still produce the proper contour, and to avoid forcing 
material under the gums. 

State the advantages and disadvantages of a matrix. 

A matrix converts a complicated compound cavity into a simple one 
and facilitates contouring. It also obstructs the light and view, and 
renders the adaptation of gold to margins at the cervix more difficult. 

In what class of cavities in the anterior teeth is the use of a 
matrix an assistance in the introduction of gold fillings? 
Describe the application and use of such a matrix. 

It is of assistance in that class of approximal cavities where the palatal 
and labial walls must be cut back almost the entire depth of the cavity, 
allowing no lateral support for the gold during insertion. A band of thin 
steel, in width the length of the crown of the tooth, is drawn between the 
teeth under the affected tooth, and through the next interdental space. 
The opposite end of the band is stretched over the labial surface of ap- 
proximating tooth and through the next interdental space on that side. 
A piece of modelling compound is now softened and pressed against the 
palatal surfaces of all the anterior teeth. Upon hardening, the matrix 
is held firmly in place, and the cavity is converted into a simple one with 
four walls. 

Name advantages and disadvantages of the various methods 
of obtaining separation. 

The mechanical separator is the quickest, but it endangers the life of 
the pulp by strangulation at the apical foramen. Rubber is slower but 
less dangerous; however, rubber is very active and may produce inflam- 
matory conditions of the pericementum. Wooden wedges upon swelling 
are active, but their action is limited and they must be renewed. Gutta- 
percha in cavities where occlusal stress may be utilized is best, because 
its action is constant and non-irritating. For anterior teeth, linen tape or 
cotton wrapped on silk ligature and knotted between the teeth, is active 
and slow enough to be non-irritating. 

Describe the application of the mechanical separator as a 
means of securing space. 

The jaws are opened by means of a threaded screw. One jaw or 
point is placed labially, and one palatally or lingually in the interdental 
space, care being taken not to infringe too much on the gum. A piece of 
thin tape or cotton will protect the gum. The thumb screw or nut is 
now tightened, drawing the points together and separating the opposing 
teeth. 

What pathologic conditions may result from wedging the 
teeth? 

Strangulation of the pulp at the apical foramen, producing hyperemia, 



KXTKNSION FOR PREVENTION 339 

sometimes followed by death of the pulp, putrefaction, and alveolar 
abscess. 

Why is wedging of superior central incisors a critical opera- 
tion in children's teeth? (b) Give a safe method of performing 
this operation. 

There is danger of opening the intermaxillary suture, (b) by the 
slow action of a silk ligature, wrapped with cotton knotted between the 
teeth. 



What is operation "extension for prevention?" How and 
why is it performed? 

It is the extension of cavity margins to a point easily kept clean and 
therefore less liable to recurrence of decay. It is performed by means of 
chisels, stones, or burrs. 

Describe your method of preparing and filling approximal 
cavities in bicuspids. 

Simple approximal cavities are entered with the burr from the buccal 
side, enlarged and made retentive with a small burr and filled with sponge 
gold. 

When decay has approached the occlusal surface, the enamel is 
drilled through or broken down with chisels. The decay is then removed 
and the cavity formed with a flat cervical floor, flat walls trimmed until 
strong and beveled. The cavity is cut back into the occlusal surface and 
made retentive. Retaining grooves are cut in the lingual and buccal 
walls at the cervical floor. After proper separation has been obtained, 
the rubber dam and matrix are adjusted. Large pieces of sponge gold 
are placed on the floor and condensed with broad faced foot pluggers, 
continuing until the occlusal floor is reached, when cohesive foil is used to 
complete the contour and the occlusal surface. Care should be exer- 
cised to cover margins, to produce a contact point in lower third of con- 
tour and to preserve interdental space. The filling is finished with 
proximal trimmers, strips, disks, and plug finishing burrs. 

Give treatment of a lower third molar having many grooves 
or sulci radiating from a common center when caries appears on 
the occlusal buccal surface. 

If only the occlusal surface is involved, the cavity should be cut 
back to include the ends of all sulci. If the buccal cavity involves the 
occusal surface, the two cavities should be made into one. Gold inlay 
makes a desirable filling for this kind of cavity. 

Give method of treating and filling approximal cavities in 
permanent teeth of children when these teeth are deficient in 
lime salts. 

Remove decay thoroughly; sterilize with carbolic acid, followed by 
blasts of hot air. Fill with guttapercha. 



340 OPERATIVE DENTISTRY 

Give the procedure, including the special approach and 
cavity form, in preparation of cavities for filling, on proximal 
surfaces of incisors and cuspids, not involving the incisal angle. 

Ample separation being secured, the frail enamel walls should be 
broken away with chisels, leaving as much of the labial wall as possible. 
With a rose head burr the cavity is enlarged palatally to secure good 
approach. All carious or decalcified tissue is burred out, and the cer- 
vical floor given a flat aspect. Margins are now smoothed and beveled 
(if gold is to be used), retaining pits drilled in cervical floor, and a small 
retaining groove near incisal margin. 

Describe in order of procedure, the preparation of a deep 
occlusal cavity in a superior molar. 

The frail edges of enamel are broken down with chisels. The thick 
leathery decay is removed in layers with large spoon-shaped excavators. 
The blade of excavator is inserted under edge of carious matter, which is 
then loosened with draw cuts, layer after layer, until all is removed. A 
large rose head burr, revolving rapidly in the engine handpiece, is now 
used, beginning at the junction of the dentin and enamel and working 
around the edge of cavity, gradually going deeper until the floor of cavity 
is reached. The rose head burr should also be used on the cavity floor. 
If the cavity has approached close to the pulp, a layer of oxyphosphate 
should cover the cavity floor to a third of the cavity depth, after which 
the walls of the cavity should be grooved with a wheel burr. The cavity 
is now ready for filling. 

Give the treatment and care of the teeth in case of white 
decay. 

White decay is decay developing so rapidly that staining has not 
taken place. The cavity should be excavated beyond the danger zone 
and filled with guttapercha. The patient should be given rigid instruc- 
tions in prophylactic care, and frequent examinations should be made. 

What is the best treatment to render a cavity aseptic? 

Thorough removal of decay followed by a bath of carbolic acid of at 
least two minutes' duration. 

Give a general rule for the preparation of cavities. Name 
the points that require special care in excavating. 

Removal of all decayed tissue is imperative. Cavities should be 
formed retentive in shape, if possible, with flat floor and walls, frail walls 
broken away, and be made easy of access. Care should be taken not to 
expose the pulp or to destroy the curve of the margins. 

How should cervical cavities be prepared in reference to the 
gum margins? 

The gums should be sealed back with guttapercha for a few days to 
allow free access to the cavity. The cervical margin should be extended 
so that the gum will cover it when it returns to the normal line. 



FILLING MATERIALS 341 

Why should interproximal spaces be retained in restoring 
adjoining teeth? State how these spaces are preserved in 
such a case. 

In order to maintain proper occlusion, to preserve self-cleansing 
vents in the mastication of food, and to eliminate lodging places for food 
debris. Interproximal spaces are preserved by separating teeth and 
building contour to a small contact point well above gingival line, thus 
allowing the gum to fill naturally the interproximal space. 

For what class of teeth and for what operations is phosphate 
of zinc valuable? 

For frail teeth and for teeth imperfectly calcified; for deciduous 
teeth and for temporary fillings; as a step in deep compound cavities. 
It is used in conjunction with other filling materials such as amalgam, 
gold, etc., and for setting crowns, bridges, inlays, and orthodontia 
appliances. 

Under what condition is oxyphosphate used as a treatment 
filling? 

It is frequently used as a temporary filling to seal such treatments 
as arsenic; to prevent the escape of drugs upon the gum. It may be 
said to be a treatment filling when it is used to strengthen frail enamel 
walls, or when it is used to lighten the background under thin, dis- 
colored enamel. 

In what class of cavities is cement unsafe? 

In cavities where excessive mastication takes place, and also in incisal 
edges and corners. In extremely deep cavities in vital teeth the phos- 
phoric acid generated while the cement is setting is irritating to the pulp. 

In what class of operations is the oxychlorid of zinc indi= 
cated? 

In filling root canals, capping pulps, lining cavities, and for tem- 
porary fillings over treatments. 

What qualities are most desirable in a filling material for 
permanent operations? 

Ease 'of manipulation, adaptability to walls and margins, insolubility 
in the oral fluids, resistance to wear, and inoffensiveness of color. 

Under what conditions are the plastic fillings preferable to 
gold? 

In deciduous teeth; in teeth with frail walls; for temporary fillings; 
and where difficulty of access renders perfect adaptation of gold impos- 
sible. 

What advantage has guttapercha as a filling material? 

It is non-conductive, insoluble, and easily placed. It is valuable in 
deciduous teeth. 



342 OPERATIVE DENTISTRY 

In what class of cavities should guttapercha rather than 
metallic fillings be used? 

In deep cavities where there is no stress of mastication and where a 
metallic filling would produce thermal shock. In cavities extending 
beneath the gum, and in teeth poorly calcified. 

Describe the insertion and finishing of a guttapercha filling. 

The cavity should be prepared with slight undercuts, dried and 
wiped out with oil of eucalyptus, the guttapercha warmed until plastic 
and inserted in pieces with a blunt instrument, care being taken that 
margins are well sealed. The filling is then trimmed with warm, sharp- 
bladed instruments, and the surface smoothed with pledgets of cotton 
dipped in chloroform. 

What advantages has amalgam over gold for filling teeth? 

In the ease of manipulation, particularly in cavities difficult of access; 
in the saving of time, as a dam is seldom necessary. 

What are the physical changes in an amalgam filling after 
it is placed in a tooth? 

It crystallizes, becomes hard (sets), and contracts or expands slightly. 

Prescribe a method of introducing and finishing at one 
sitting amalgam fillings in approximo=occlusal, adjoining 
cavities in the first and second superior bicuspids. 

The teeth are separated, and a matrix adjusted around each tooth. 
A mechanical separator or wooden wedge, forced between the matrices 
at the cervical margin of cavities, keeps the matrices firm and tight 
at said margin, and maintains the separation during operation. The 
amalgam is introduced in small pieces into each cavity and condensed, 
and the occlusal surface trimmed to margin. Matrices and separator 
are now removed, and approximal surfaces finished with thin linen or 
silk tape, care being exercised to preserve contact point and contour. 

In what class of cavities is tin preferable for filling? 

In deciduous teeth and in cavities where the constant antiseptic 
action of tin is indicated. 

State why tin fillings arrest decay in teeth when gold fillings 
fail. 

Tin, being more malleable, adapts itself more closely to the cavity 
walls. Tin also possesses lasting antiseptic properties. 

Mention the form and condition of tin best suited for filling 
teeth. How may the cohesive property of tin be preserved? 

In the form of No. 4 or No. 5 foil in sheets. It should be cohesive. 

Its cohesive property is preserved by keeping it in a dry place near 
an open bottle of ammonium nitrate and always handling on a piece of 
chamois. Annealing on a mica tray over a spirit lamp at the time of 
operating will increase the cohesiveness. 



GOLD FILLINGS 343 

Describe the method of inserting a filling of tin. 

Rubber dam should be applied, and tin introduced in ropes or 
small pieces, using well serrated pluggers. The walls and margins are 
covered, and the tin thoroughly condensed, after which the cavity is 
filled and malleted. Finishing is done with small revolving stones, 
plug finishing burrs, and burnishers. 

What are the characteristics that render gold such a desirable 
filling material? 

Malleability. Density when malleted. Purity. It remains un- 
changed in the fluids of the mouth. It is inoffensive in color and takes a 
high polish. It is non-irritating to the soft tissues. 

How should a cavity be prepared for a gold filling? 

In general with beveled margins, flat floor and retaining pits or grooves 
where the walls rise from the floor. Frail walls should be chiseled away 
until strong enough to stand the jar of the mallet. 

How should the preparation of a cavity for gold filling differ 
from the preparation of a cavity for an amalgam filling? 

A cavity to receive gold should be angular in shape and easy of access, 
with margins beveled outward. Retaining pits or grooves should be 
formed. For amalgam the cavity may be approximately spherical and 
the margins should be vertical and generally retentive. 

What special precautions should be observed in inserting 
gold fillings in approximal cavities? 

The margins should be extended so as to be readily reached by the 
tooth brush and the contour of the tooth restored to preserve correct 
contact point. Undercuts should be made in cavity walls as well as 
in the floor. 

State the advantages of cohesive gold. Give reasons. 

When properly welded the separate piecs form a solid mass, so that 
contours and corners can be safely built up. 

Mention a preferable method of annealing gold foil while 
introducing a filling. Give reasons. 

Upon an electric annealer. The degree of heat can be accurately 
determined and controlled, and the gold can be kept warm and free 
from atmospheric moisture until ready to be placed in the cavity. 

Give the technic of preparing and filling with cohesive gold 
an approximal cavity. 

After obtaining ample separation, the dam is adjusted and the frail 
walls broken away. As much as possible of the labial wall should be left. 
All decay is removed with excavators or burrs, until the cervical floor and 
margin form a flat aspect with not too sharp corners. Retaining pits or 
grooves are cut in the dentin near the floor and toward the incisal border. 
The margins are smoothed and beveled. The gold is introduced in small 
pieces with finely serrated pluggers, filling retaining pits and covering floor 
first, and gradually working toward the incisal border. Keep margins 



344 OPERATIVE DENTISTRY 

covered and working surface flat, but slightly higher against palatal wall. 
At all times care should be taken to keep gold between plugger and enamel 
and to condense each piece thoroughly before inserting the next. 

What is the difference between cohesive and noncohesive 
gold? State the working method of each. 

Cohesive gold is perfectly clean annealed gold retaining the property of 
cohesion. It is worked by welding piece on piece to a solid mass. 

Noncohesive gold is the same as cohesive except that a thin film of 
some substance is deposited on its surface which destroys its cohesive 
property, but renders it very soft to manipulate. It is worked by tightly 
wedging piece against piece. 

In what respect is noncohesive gold preferable to cohesive 
gold for filling teeth? 

It can be more closely adapted to the walls of the cavity, particularly if 
they are frail. It is more rapidly worked than cohesive, and requires 
less malleting. 

Where would you use noncohesive gold? 

In small but simple cavities with four walls. To line frail walls in 
cavities finished with cohesive foil. In large occlusal cavities not includ- 
ing an approximal surface, noncohesive gold can be worked very rapidly. 

Describe the preparation of hand made noncohesive gold 
cylinders and state in what cases and in what manner they 
should be used. 

Wrap a long strip of foil around a very thin instrument or broach, 
and cut short sections with a sharp knife or foil scissors. They should be 
used in simple cavities with frail walls, in occlusal cavities of molars, in 
proximal cavities extending under the gum, and in combination with 
cohesive foil. They are placed in a cavity loosely and on end, a dull 
pointed instrument is inserted in the center, and with a rotary motion the 
cylinders are burnished against the walls. 

Give technic of preparing and filling an approximal cavity 
with noncohesive gold. 

Adequate separation is obtained; the cavity prepared with flat floor, 
and pulpal wall with smooth margins. The cavity is made larger inside 
than at the margins by means of inverted cone burrs. The gold in the form 
of cylinders is placed flat on the floor and packed down with broad-faced, 
finely serrated pluggers. The cavity is then filled with cylinders laid at 
right angles with the margin and extending some distance beyond them. 
A sharp-pointed instrument is forced into the center and, with a rotary 
motion, the gold is forced against the cavity walls. This process is repeated 
until the wedge can no longer be inserted, when the surface is condensed 
with a foot plugger in a mallet, and the gold burnished well over the mar- 
gins. The filling is now ready for the final finish with plug finishers, 
strips, disks, etc. 



GOLD FILLINGS 345 

Give the technic of preparing an approximal cavity and of 
filling it with crystal gold. 

The cavity is prepared with well defined margins slightly beveled, the 
floor flat, and the cavity generally retentive in shape. The gold is torn oil 
in small pieces and packed against the flat floor with a broad-faced foot- 
plugger, covering the cervical margin. With this floor portion well seated 
and condensed, the remainder of the filling is built up, using large round 
pointed pluggers with shallow serrations running well up over the edges. 
The filling is inserted with hand pressure, condensing the surface with 
a mallet to insure a bright polished surface. 

Describe a method of filling an occlusal cavity in a molar 
with shallow sulci radiating from a deep central cavity. 
Describe the form and condition of gold used in the operation. 

The deep central cavity may be rapidly filled with sponge or with 
semicohesive gold to the level of the floor of the sulci. Begin at the outer 
end of each sulcus with cohesive foil and w r ork to the center, being 
careful to anchor the gold at the end of each sulcus. 

Describe a method of securely anchoring a gold filling in a 
distal cavity with frail palatal walls in a vital superior cuspid. 

The floor is made flat with a deep groove or pits near the labial and 
lingual angles. The cavity may be extended on the palatal surface near 
the incisal edge and given a retentive form. 

Give method of treating and filling a very sensitive super= 
ficial cavity with gold. 

After dam is applied and cavity dried, Robinson's remedy or carbolic 
acid is applied and driven in with blasts of warm air until the extreme 
sensitiveness is relieved. The cavity is then lined with cavitine or chlora- 
percha. It may then be filled with sponge or noncohesive gold to avoid 
the shock of malleting. 

State the best method of applying gold to the walls of cavities 
in poorly calcified teeth. 

The walls should be lined with oxyphosphate of zinc cement, and 
noncohesive gold cylinders pressed and burnished against the w r alls w T hile 
cement is still soft. When cement hardens, the filling is completed with 
cohesive foil in the usual way. 

What are the comparative merits of hand and mallet 
pressure? 

Hand pressure produces less shock to the tooth and is better tolerated 
by the patient. It is less liable to fracture frail walls, and is valuable in 
working noncohesive foil and sponge gold. The blows from a mallet 
produce greater condensation and therefore create a surface more resist- 
ant to the wear of mastication. 

What causes the surface of gold fillings to blacken in some 
mouths? 

The staining by sulphids contained in the saliva and in certain 



346 OPERATIVE DENTISTRY 

medicinal substances. Contamination with mercury or other foreign 
particles during the introduction of the rilling. 

When the walls of a cavity have softened beneath an approxi= 
mal gold filling extending beneath the gums, how should the 
cavity be treated and filled? 

After all the decayed tissue has been carefully removed, the cavity 
is formed so as to give it a retentive shape. Base plate guttapercha should 
be forced into and around the cavity to seal the gums back. At a future 
sitting the cavity is filled with permanent guttapercha or sponge gold. 

In what class of cavities and in what condition of teeth is 
the gold inlay indicated? 

In teeth too frail to withstand malleting and in large compound cavi- 
ties in bicuspids and molars; in distal cavities in canines; occlusal cavities 
in molars; in cavities where it is difficult to exclude moisture. 

Describe a method of making gold inlays. 

The most common method is by casting. The cavity is prepared 
with square walls and angles, but without undercuts. Wax, prepared 
for the purpose, is softened in hot water, and a piece a little larger than 
the cavity is introduced and pressed into place while soft. The patient 
is requested to bite, which gives the operator the position and occlusion 
of the opposing tooth. The wax is now trimmed to contour and margins, 
and removed from the cavity with a sharp, hook-shaped instrument. A 
piece of wire is heated and embedded in the wax. The wax is now coated 
with a non-shrinking investment compound. A small brass or iron ring is 
filled with the same material, and the wax embedded, allowing the wire 
to protrude. After the investment hardens, the wire is removed. The 
case is now heated to burn out the wax mold, and the investment given 
the form of a crucible. Pure gold is now melted in the crucible formed 
on top, and, by means of any of the approved appliances, forced through 
pressure or vacuum suction to fill the cavity formerly occupied by the wax. 
Upon cooling, the investment is washed off, the cavity undercut, and 
the inlay cemented in place. 

Describe (a) a method of preparing a cavity for a cast gold 
inlay for an abutment, (b) Give the manipulative procedure for 
making the inlay. 

(a) If a molar tooth is used, the proximal cavity is cut with parallel 
walls and flat, cervical floor; it is then cut well back on the occlusal 
surface and enlarged to form a dove-tail. Undercuts should be avoided, 
and the margins should be vertical or slightly beveled, (b) The ma- 
nipulative procedure is given in preceding question. 

How should an amalgam filling be inserted in a com= 
pound cavity, involving the approximal and masticating sur= 
faces of a molar? 

A matrix should be applied to the tooth and burnished well against 
approximating tooth to form a simple cavity. Amalgam is inserted from 
masticating surface and allowed to set before matrix is removed. This 
is in order to restore the contact point. 



AMALGAM FILLINGS 347 

Describe in detail the method of restoring frail, broken crowns 
with a combination of amalgam and cement. 

Remove all decayed tissue with round burrs, trim margins, but 
retain walls as far as possible. Protect tooth from moisture, wipe 
cavity with carbolic acid, and dry out. Flow thin, but quick-setting 
cement into the cavity, and, while still soft, introduce amalgam, burnish- 
ing from the center to the margins. The cement will be forced into all 
interstices and support the frail walls. The excess cement is wiped 
from margin and the amalgam burnished over. Polish at subsequent 
sitting. 

How should margins of a cavity wall be prepared for an 
amalgam filling? 

As near as possible at a right angle with the tooth surface, to avoid 
thin edges in the finished filling. 

State the conditions under which amalgam should be used for 
fillings. Give reasons. 

When gold is counter-indicated because of inaccessibility or lack 
of strength in cavity walls, and when the filling will not be in an exposed 
position; amalgam is used in deciduous molars because of the ease of 
manipulation; in cavities so extensive that proper formation for gold 
filling would involve too great tooth destruction. 

State advantages of amalgam over other plastic fillings. Give 
reasons. 

Because amalgam is harder and less soluble than the others, resists 
wear better, and is more permanent. 

(a) What qualities should an amalgam as a filling material 
possess? (b) What treatment of an alloy is necessary to make 
it constant? 

(a) It should be impervious to the fluids of the oral cavity, and should 
neither contract nor expand on setting. It should set reasonably fast and 
retain its color. 

(b) The weight, annealing, and fusing of constituent metals should be 
constant for the same alloy. The proper weight of alloy and mercury 
should be ascertained in mixing an amalgam and always adhered to. 

How would you prepare and fill an approximal cavity with 
frail walls extending to the cutting edge? 

Ample separation being secured, the frail walls are chiseled away, 
and cervical floor and wall over pulp made flat. The labial margin 
should present a curve from cervical border toward the center of the 
tooth, and continue in a straight line with the long axis of the tooth to the 
incisal edge. The palatal margin should be in accord with the labial to 
within four or five lines of the incisal edge, where a turn at right angles 
and a dovetail in the strong tissue give a strong retention at the incisal 
edge. Retaining pits are drilled labially and palatally in the dentin 
at the angle of the cervical floor. After the margins are beveled and 
smoothed and the dam adjusted, cohesive foil in the form of cylinders is 



348 OPERATIVE DENTISTRY 

packed in the cervical retaining pits, and the floor covered and burnished 
over the cervical margin. The gold is now introduced in small cylinders, 
building out the contour and condensing as it is put in, keeping the work- 
ing surface at right angles with the walls. When incisal edge is reached, 
the gold is worked into the incisal dovetail, and the whole surface well 
condensed with broad faced, foot shaped pluggers and malleted. The 
rilling is now ready for the final burnishing and trimming, after which 
it is finished with strips and disks. 

Name the different materials used in filling teeth? 

Gold, porcelain, amalgam, tin, guttapercha, oxyphosphate of zinc, 
oxyphosphate of copper, and oxychlorid of zinc. 

Give method of preparing and filling a cavity in a molar of 
which only the buccal and palatal or lingual walls remain. 
How may fracture of the walls be prevented? 

Decay is removed and walls squared, preserving as much- dentin 
as possible. Oxyphosphate of cement mixed thin enough to be sticky 
is introduced and allowed to harden partially. It is now trimmed down 
flat on the occlusal surface, exposing the margins and leaving enough 
space for amalgam covering only. At the mesial and distal portions of 
cavity a sharp step is formed, extending to the cervical floor. Retaining 
grooves are cut in these steps, a matrix placed around tooth, and the 
entire tooth filled with amalgam. The cement will bind the walls together 
and there will be less volume of metal to cause weakness by expansion. 

Mention the various combination fillings and state the 
advantage of their use. 

Gold and amalgam, gold and tin, gold and cement, noncohesive and 
cohesive gold, crystal or sponge gold and foil; amalgam and cement, 
amalgam and guttapercha; guttapercha and cement. In combining 
filling materials the aim is to utilize the best properties of one and offset 
its disadvantages with the best properties of the other. 

Mention the class of cavities in which a combination of 
noncohesive and cohesive gold should be used. Give reasons 
for their use. 

In approximal cavities in the anterior teeth, where it is necessary 
to retain frail walls. In poorly calcified teeth, because of the better adap- 
tation of the noncohesive variety. In compound cavities in bicuspids 
and molars, extending to or under the gum margin, noncohesive gold can 
be used for two-thirds of the cavity because of its greater adaptability 
and ease of manipulation; these cavities are finished with cohesive foil 
to obtain better contour and hardness on the masticating surface. Large 
occlusal cavities in molars can be two-thirds filled with noncohesive 
gold to save time, and finished with cohesive gold to obtain greater 
density. 

Give the technic of filling a cavity with a combination of 
cohesive and noncohesive gold. 

The tooth, say an upper first bicuspid, with a mesio-approximal 






COMBINATION FILLINGS 349 

cavity including the occlusal surface, is isolated with the approxi- 
mating tooth by means of a rubber dam. A matrix is adjusted, if neces- 
sary. Noncohesive gold in the form of large cylinders or tape is laid 
on the flat lloor, and malleted into place with a broad foot pluggcr. 
More gold is added and malleted, keeping the margins well covered, 
until the floor of the occlusal portion is reached, when cohesive foil 
is used to complete the occlusal surface and the contour to the contact 
point with the approximating teeth. 

Describe the manner of preparing gold and platinum for 
filling cavities in teeth. State the advantages of such fillings. 

A sheet of gold foil and one of platinum are folded together into 
strips or rolled into a cylinder. Small sections are cut with a sharp 
knife or foil scissors. The advantages are (i) that a much denser 
surface is obtained, which is more resistant to the stress of mastication, 
and (2) the color, being lighter, is more pleasing than gold by itself. 

Give the technic of filling with gold and tin. 

The floor, walls and margins are covered with tin, introduced in the 
form of ropes or strips. The remainder of the cavity is finished with 
gold, and the gold burnished over the tin at the margins. Gold and tin 
are sometimes used in the form of a sheet of tin interposed between two 
sheets of gold, folded, and cut in strips. 

Mention a class of operations in which a combination of gold 
and amalgam is preferable to either material used separately. 
Give reasons. 

Mesio-occlusal cavities of molars and disto-occlusal cavities of 
bicuspids, where the dark color of amalgam is unsightly and yet the 
cervical portion of the cavity is unfavorable to the perfect adaptation of 
gold. Amalgam can be used up to, or slightly above the gum margin, 
and the remaining portion finished with gold. 

Give technic for inserting a combination filling of gold and 
amalgam. 

Protect the tooth from moisture with dam and adjust matrix, wedging 
it tight at cervical margin. Use a quick setting alloy with a minimum 
of mercury and fill to slightly above the gum margin, packing and bur- 
nishing with considerable pressure. Cover amalgam with several layers 
of sponge or noncohesive gold and condense with broad-faced pluggers. 
The gold will adhere to the amalgam firmly, and the filling can be com- 
pleted with cohesive foil and finished with plug finishers, strips, disks, etc. 

Describe a method of restoring with a combination of gold 
and cement badly decayed, frail crowns of teeth. 

Decayed tissue is thoroughly removed with rose head burrs. The 
cavity is two-thirds filled with cement, squaring up the walls with the 
material up to, but not over the margins. After the cement hardens, 
a circular retaining groove is cut with a wheel burr, and the remaining 
third of the cavity filled with gold foil, burnishing well over the cement 
at the margins. 



350 OPERATIVE DENTISTRY 

Designate a class of cavities in frail teeth in which a com=> 
bination filling of guttapercha and zinc phosphate is indicated, 
and give technic of operation. 

Those cavities extending well up under the gum. The gums having 
been sealed away for several days with base plate guttapercha, the cavity 
is dried and protected from moisture. Permanent guttapercha is softened 
with heat and packed in the cervical portion to a little above the gum 
margin and smoothed with a hot instrument. The remainder of the 
cavity is filled with cement to strengthen the frail walls. 

State the advantages of the silicate cements for fillings. 
Give the technic of their mixing and insertion. 

The color is harmonious and they have more translucency than oxy- 
phosphates. They resist stress to a marked degree and are far more 
permanent than the oxyphosphates. 

Cavities are prepared with sharp, well-defined margins and undercut. 
The powder is placed on a glass slab near the liquid in the proportion 
of four to one by bulk. The powder should be drawn into the liquid 
rapidly, a little at a time, and thoroughly spatulated with a bone or 
ivory spatula until quite stiff. It is packed in small pieces in the cavity, 
using considerable pressure. Shell or ivory instruments are used. The 
contour is formed and the surface burnished. The rubber dam should 
always be used, and the filling protected further by coating the surface 
with sandarach shellac or sticky wax before removing the dam. It is 
imperative that the filling be kept dry for three-quarters of an hour or 
longer. 

What are the advantages of the porcelain inlay as a filling 
material? 

Its harmonious color and non-conductivity render it valuable for 
anterior teeth and teeth with frail walls. Its use avoids the necessity of 
malleting in frail, sensitive teeth. 

What class of cavities and what conditions of the teeth are 
most favorable for the insertion of porcelain inlays? 

Labial and buccal cavities. Approximal cavities in the anterior 
teeth. Teeth with frail walls and where the display of gold would be 
too extensive. 

What is meant by the terms high and low fusing bodies? 

High fusing bodies are those which require the heat of an electric 
or high pressure gasoline furnace to fuse them; the fusing point is be- 
tween 2200 F. and 2600 F. Low fusing bodies glaze at much lower 
temperatures, an alcohol flame being sufficient in most cases. 

What are the advantages of high and low fusing porcelains? 

The advantages of low fusing porcelain are: the low temperature 
required and consequent ease of manipulation, and the lessened liability 
to changing the color during baking. The advantages of high fusing 
porcelain are the more lasting qualities of the porcelain in the fluids 
of the mouth and the permanency of the color; the absence of pits 



POK( ! IAIN INLAYS 35 1 

when properly fused; and the superior glaze. The disadvantages are 
the high temperature required, and the danger of altering the color 
during the baking process. 

Give two methods of making matrices. 

Matrices may be burnished directly into the cavity or may be swaged 
into a model. In the latter method an impression in dentalac is secured 
and a model of Spence metal run. The matrix should be placed in the 
cavity for more accurate adaptation after being swaged on the Spence 
metal die. 

Compare the shading of a gingival margin inlay with an 
inlay for a simple approximal cavity. 

As a rule gingival inlays should be a shade darker, and approximal 
inlays a shade lighter than the true shade of the natural tooth. 

Give the technic of the operation of restoring teeth by the 
use of porcelain inlays. 

The cavity is prepared with flat floor and walls, without undercuts, 
plenty of separation being secured by any of the approved methods. The 
margins should be at right angles with the surface of the enamel and 
smoothly polished. A piece of platinum one one-thousandth (i/iooo) 
of an inch is placed over the cavity and forced into place with a burnisher 
and wet cotton. Holding the platinum firmly in place, taking care that 
the margins are well covered, it is burnished until a perfect matrix of the 
cavity is obtained. Porcelain powder of the correct shade is mixed with 
clear water to the consistency of vaselin, and the matrix filled with it, 
dried and placed in the mufHe of an electric furnace. When fused it is 
removed and cooled and more porcelain is added to restore contour. 
Again it is dried and placed in the furnace until the surface is glazed. The 
platinum is now removed and the cavity surface etched with hydrofluoric 
acid, or grooved with fine stone disks. The cavity is dried, undercut, and 
filled with soft cement. While the cement is still soft, the inlay is pressed 
into place and wedged until the cement hardens. 

Describe the technic of making and inserting a porcelain 
inlay in a distopalatal cavity of an incisor. 

If the position of the tooth or cavity prohibits the burnishing of a 
matrix to the cavity, an impression is taken with dentalac. A model of 
amalgam or Spence metal is constructed from this impression. Platinum 
foil is burnished or swaged to this cavity model, then removed and filled 
with the porcelain powder, which has been spatulated to a creamy con- 
sistency with distilled water. Excess moisture is removed with blotting 
paper and by drying before mufHe door. The case is now placed in the 
furnace and biscuited, removed, built to contour, again placed in the 
furnace and glazed. The platinum is now stripped off, and the cavity 
surface of the porcelain roughened with fluoric acid or grooved with 
stone disks. The cavity is dried and half filled with oxyphosphate 
cement, mixed thin. The inlay is placed in the cavity, displacing excess 
cement, and held firmly until the cement has hardened. Excess cement 
is trimmed away, and margins coated with sandarach varnish. 



352 OPERATIVE DENTISTRY 

How may excessive contraction be avoided in making large 
contour porcelain fillings? 

By using porcelain as dry as possible, and by imbedding small pieces 
of the porcelain tooth in the mix for the first bake. By cutting long 
gashes in the first mix, while in the matrix, and filling up the cracks before 
the second bake, the porcelain will not be pulled from the margins by 
contraction. 

What methods are there for the retention of porcelain 
inlays? 

Proper shaping of the cavity so that the inlay will withdraw in only one 
direction; fusing of platinum pins in the under surface of porcelain; 
undercutting the cavity and the under surface of the inlay before setting 
and etching the under side of the inlay with hydrofluoric acid. Cement 
is used as a means of retention in all cases. 

What color cement should be used in setting porcelain 
inlays? 

Cement as near the color of the inlay as possible; or a little lighter or 
darker, to overcome the change of color in the inlay due to the diminished 
refraction of light when inlay is backed with cement. 

When is the extraction of teeth indicated? 

When badly exostosed, when denuded of pericementum by pyorrhea 
to such an extent that they cannot be made firm. When in necrosed sock- 
ets, or when their presence interferes with the proper fitting of an arti- 
ficial denture. An abnormally erupting third molar, which cannot be 
guided to its proper position and is causing inflammatory or neuralgic 
conditions, should be extracted. 

When is the extraction of deciduous teeth indicated? 

Except when badly decayed, every effort should be made to save 
these teeth until the time for the permanent teeth to erupt. They should 
be extracted, however, if badly diseased, or if their presence is obstructing 
the eruption of the permanent teeth, or causing irregularity in the perma- 
nent set. 

What (if any) possible evils may arise from premature 
extraction of temporary teeth? 

Impaction of permanent teeth or irregularities of occlusion. 

State under what conditions the extraction of the sixth year 
molar is permissible. 

Only when it is so badly decayed or diseased that it cannot be saved, 
or when the surrounding bone is necrosed. The danger of malocclusion 
is less if extracted just prior to the eruption of the second molar, which 
would then in most cases take its place and fill the gap, preserving the 
arch. 

At what age is it best to extract the first permanent molar? 
Give reason. 

If possible, it should be saved until the second molar is about to erupt. 



EXTRACTION 353 

This will prevent irrcgu arities of occlusion, and the second molar will 
usually move forward into the socket of the extracted first. 

Describe the operation of extracting incisors, cuspids, 
bicuspids, and molars. 

Superior incisors are rotated to loosen them and drawn out in a 
straight line. Cuspids and lower incisors slightly rotated, moved outward, 
inward, then down and out in straight line. Superior bicuspids and 
molars are worked inward, then outward, then drawn. Inferior bicuspids 
and molars are worked outward, then inward, then drawn. 

Give method of extracting the roots of an inferior third 
molar when the crown is broken off and the gums swollen. 

They may be extracted, after free access is gained by lancing the gums 
buccally and lingually, with forceps, turning them upward and backward. 
If the crown is broken away and the roots separated, an excavator may 
be used to turn the roots in the same direction. 

Mention some of the conditions which necessitate special 
precaution in extracting teeth. 

Impacted teeth, teeth with frail crowns, crowded dentures, exostosed 
roots, roots badly cupped with decay, teeth in extremely frail mandibles, 
and teeth in the mouths of people of a hemorrhagic diathesis. 

How, as a rule, should force be applied in the extraction of a 
lower third molar? 

Upward and backward. 

Give the treatment of an impacted lower third molar. What 
pathologic conditions may be caused by lack of treatment? 

Depending on the position of the impacted tooth, there are several 
methods of treatment. If impinging on the roots of the second molar, 
the latter may be extracted, allowing the third molar to take its 
position in the vacant socket. If not impinging on second molar but 
causing pathologic conditions, an incision is made in the overlying 
tissue, the bone burred or chiseled away, and the tooth extracted with 
forceps or elevator. It is sometimes advisable to divide the tooth with a 
thin revolving stone or saw, and remove it in sections. 

What accidents are liable to happen during the extraction of 
teeth? 

Excessive hemorrhage, fracture of mandible, tuberosity, or alveolar 
plates, dislocation of mandible, injury of inferior dental nerve or artery, 
the breaking of tooth or roots, and extraction of more than one tooth on 
account of fused roots. 

What injuries may occur, and what tissues be involved 
through carelessness in extraction of the superior third molar 
teeth? 

Fracture of the tuberosity; laceration or abrasion of the anterior 
pillar of the fauces or of the cheek; fracture of opposing teeth with the 
body of forceps. 
23 



354 OPERATIVE DENTISTRY 

What anatomical irregularity of the inferior third molar too 
frequently presents itself in extraction? How would you 
extract it? 

The hook-shaped curving of one or more roots. To extract, the 
force should be applied in the direction of the curve of the roots. It is 
sometimes necessary to take a radiograph to determine the curve of the 
root and to cut away the overlying bone, or split the tooth and remove 
it in sections. 

Give method of extracting a tooth with the root so enlarged 
by exostosis that its removal through the socket must result in 
fracture of the jaw. 

The gum is lanced, exposing the thinnest alveolar wall over the 
exostosed root. The alveolar plate is cut away until the tooth can be 
loosened and removed. 

Describe the treatment of excessive hemorrhage following 
tooth extraction. 

Pack socket with strips of gauze saturated with a solution of tannic 
acid. If this fails, fill socket with plaster of Paris or modeling com- 
pound, cover with a compress, and bandage the jaws tightly. Apply ice. 
Inject ergot. 

What anatomic changes are produced by the loss of teeth? 

Changes in occlusion or articulation, absorption of alveolar process, 
and consequent falling in of the lips and cheeks. 

Describe the method of preparing and inserting an amalgam 
filling. 

The correct proportions of alloy and mercury should be placed in a 
mortar and thoroughly incorporated by means of a pestle. The mass is 
then kneaded in chamois skin or the palm of the hand, the excess of mer- 
cury being expelled by pressure, and washed in the palm of the hand with 
a saturated solution of sodium bicarbonate to remove the oxids of tin and 
silver. The amalgam is introduced into the cavity in small pieces and 
burnished against the walls and floor. When contoured, the excess of 
mercury is removed with spunk or pure tin, the margin smoothed with 
thin-bladed instruments or thin tape, and at a subsequent sitting polished 
with strips and disks. 



PROSTHETIC DENTISTRY 



What constitutes the basis of prosthetic dentistry? 

Thorough training in the science of dentistry, coupled with mechan- 
ical skill and artistic sensibility. 

Mention some of the affections of the mouth that may, till 
remedied, contra=indicate the insertion of artificial teeth. 

Infected sockets after extraction, necrosis of the bone, abscesses, 
ulcers, or any inflammatory condition which would be increased by the 
irritation of an artificial denture. 

State the characteristics of the natural gums when in a 
normal condition. 

They are pink in color, smooth, moist and noticeably lacking in sensi- 
tiveness. 

State the condition of the gums after the loss of the natural 
teeth from pyorrhea alveolaris. 

The gums themselves rapidly return to a normal state after the loss 
of a tooth or teeth from pyorrhea alveolaris, but are greatly sunken due 
to the loss of the underlying alveolar process. 

What is the cause of the absorption of the alveolar process 
after the extraction of teeth? 

The tendency nature has of ridding herself of useless tissue. The 
function of the alveolar process is to provide a firm socket for the roots of 
the teeth. When the teeth are lost the process falls into disuse and, 
owing to the cancellous structure of the bone, is quickly absorbed. 

Does absorption of the alveolar process advance more 
rapidly with or without a plate? 

More rapidly with a plate, due to pressure. 

How should the mouth be prepared to receive a full artificial 
denture? 

All remaining teeth and roots should be extracted and the membranes 
treated until in a normal condition. 

In preparing the lower jaw for artificial teeth, how many, if 
any, natural teeth should be left in the mouth? 

All that are healthy and do not interfere with the construction or use 
of the plate, providing they are not unsightly. 

355 



356 PROSTHETIC DENTISTRY 

What is the advantage of retaining sound cuspids when it is 
necessary to remove the other teeth? 

To maintain the facial expression by preventing the lip from falling 
in and, in some cases, to supply added retention from gold clasps around 
these teeth. 

When an impression is required for an artificial denture of 
any kind, what conditions should be considered? 

The shape and size of jaws, height and condition of palate with 
regard to hard and soft parts. The condition, position, occlusion and 
number of remaining teeth. The condition of alveolar ridge or any other 
condition which might tend to complicate removal of the impression. 

What muscles have a tendency to displace (a) an upper 
denture, (b) a lower denture? 

(a) Buccinator, mastoid and labial muscles. 

(b) Mastoid, mylohyoid and geniohyoglossus muscles. 

A common result of wearing lower plates that accurately fit 
a model is a tendency of the plates to bury their buccal edges in 
the soft tissues ; state how this tendency may be overcome. 

It may be overcome by filing away the buccal edge so that it will not 
unduly impinge on the soft tissue. It may be prevented by scraping this 
portion of impression before pouring model. 

How may the extreme limit of the posterior border of an 
upper plate be determined? 

By making the plate long, fitting it to the mouth, and filing it away 
until no discomfort is felt by the impingement to the posterior edge. 
Even if no discomfort is felt, the plate should be shortened till the move- 
ment of the soft palate fails to cause dislodgement. 

What determines the outlining of a full lower denture? 

The height of the ridge, amount of soft fold of mucous membrane 
and the attachment of the muscles. 

What would result if an upper denture extended too far 
posteriorly and touched the soft palate? 

The motion of the soft palate would permit the ingress of air under the 
plate, resulting in the loss of atmospheric pressure and the consequent 
dropping of the plate. 

What are the requisites for an impression material? 

Plasticity for introduction, and the property of becoming hard when 
in the mouth (setting) with the minimum of contraction or expansion. 

Mention the various materials used for taking impressions. 

Modeling compound, beeswax, dentallac and plaster of Paris. 

What is plaster»of=Paris chemically? How is it prepared for 
dental purposes? 

Sulphate of calcium from which two-thirds of its water of constitu- 
tion has been driven off by heat. It is pulverized and roasted. 



TAKING IMPRESSIONS 357 

Describe your method of taking a full upper impression in 
plaster=of-Paris. 

A suitable tray is selected and the heel built up with beeswax. The wax 
is softened; the tray inserted and pressed to place in order to make the 
wax conform to the posterior part of the palate. The tray is removed 
and filled with the mixed plaster, being higher in the center than at the 
sides, and again inserted in the mouth and pressed to place, the rear in 
advance of the front. The cheeks and lips are drawn outward and 
downward, then pressed back to place, forcing plaster well up on the 
outside of ridge. The tray is now held firm until the plaster will frac- 
ture with a clean break, when the tray, with impression, is removed, 
depressing the rear first, then the front. The patient should sit erect 
with head slightly forward. 

What is the best method of taking a partial difficult impres= 
sion? 

As outlined in preceding answer, except that the tray should be oiled 
before the plaster is placed in it, and in removing the impression, the tray 
is removed and the plaster cut away with a sharp knife and broken away 
in sections. These sections are reassembled in the tray and held together 
with wax. 

Why is plaster preferable to other materials in securing an 
impression when some of the teeth remain in the mouth? 

Because of the accuracy of adaptation of the plaster and the fact that 
there is little or no distortion upon removing the impression. The im- 
pression can be removed in sections, obtaining an accurate impression of 
undercuts, no matter how deep or complicated. 

How soon after a plaster impression is taken should the 
plaster be poured for the model? Give reasons. 

As soon as possible. If left for over a few hours the impression 
becomes bonedry and absorbs the water from the model plaster, separa- 
tion being rendered much more difficult. 

State how the setting of plaster may be hastened. 

By the addition of a little salt while mixing. 

How may nausea be prevented in a particularly sensitive 
mouth while an impression is being secured? 

Paint the hard and soft palate with a two per cent, solution of cocain or 
gargle with camphor water. 

What are the qualities of a good impression? Give test. 

It must be sharp in detail, smooth of surface and include a greater 
area than the denture is to cover. A test is the degree of force necessary 
to overcome the atmospheric pressure on removing impression. 

When may modeling compound or wax answer better than 
plaster for an impression? 

In taking an impression of a lower jaw, the alveolar process of which 



358 PROSTHETIC DENTISTRY 

has been greatly absorbed and there is marked proliferation of the soft 
tissues. The harder impression materials will press in the soft parts and 
take the impression of the ridge of bone beneath. 

Mention a good separating medium to apply to a plaster=of= 
Paris impression before pouring the model. 

Thin shellac or liquid soap. 

State the two essential requirements for the production of a 
perfectly fitting denture. 

An accurate impression and model, and bite. 

State the effect of a hard center and soft ridge on the fit of 
an upper denture. 

Unless cast has been properly treated, the plate will rock. 

How should a plaster model be treated when a portion of the 
ridge is soft and the center of the mouth hard? 

The model should be slightly scraped at the point corresponding to 
the soft tissue and a piece of thin tin or lead laid over the hard portion. 

How may plaster teeth on models be strengthened to pre= 
vent fracture? 

By sticking pins or small wire nails in the impressions of the teeth 
before pouring the model. 

Describe a method of repairing a fractured model. 

If the model is fractured through the base, the two halves are held 
together and deep undercut grooves cut in the base across the fracture. 
The model is now placed in water till thoroughly soaked, soft plaster run 
into the grooves, and trimmed flush. 

Why is a temporary denture desirable? 

To preserve the normal condition of cheeks and lips, to maintain the 
normal bite. The temporary plate regulates to a certain extent the 
resorption, making it more uniform. 

How soon after extraction of the teeth should full temporary 
dentures be inserted? Permanent dentures? 

Temporary dentures as soon as the sensitive condition of the tissues 
will permit. Permanent dentures in from six to ten months, allowing 
for full resorption to take place. 

How may a plate be prevented from rocking in a mouth 
with a hard palatal ridge? 

By scraping that portion of the impression corresponding to the ridge. 

Mention some of the causes of failure of artificial dentures. 

Imperfect impressions or models. Warping during the process of 
construction or vulcanizing. Insufficient or overvulcanizing. Faulty 
articulation. 






SELECTION OF ARTIFICIAL TEETH 359 



What properties are requisite for a good base plate? 

It should be plastic when hot and hard at the mouth temperature. 
It should be malleable, but not elastic. 

Describe the method of obtaining a correct bite for a full 
upper and lower set. 

A rim of beeswax is attached to both the upper and lower base plates, 
approximating the height of the teeth and the required fulness. The 
base plates, with attached wax, are placed in the mouth and the wax 
trimmed to the exact fulness and length of bite, with the jaws in correct 
opposition. The high and low lip lines are marked, together with the 
median line and the angles of the mouth. The bites are melted together 
at two points, with a hot spatula, and the bites with the two base plates 
removed together. 

What should be taken into consideration in selecting a set of 
teeth for an edentulous mouth? 

The temperamental class to which the patient belongs, the age, fulness 
of the lips and cheeks, amount of resorption of alveolar ridges, the length 
of upper and lower lips when at rest and when talking and laughing, 
and the length and breadth of the arches. 

State the value of the study of temperaments in the practice 
of prosthetic dentistry. 

It enables the dentist to select teeth for an edentulous mouth most 
fitting in size, shape and color to the physical characteristics of the 
individual. 

Describe the size, form and color for (a) a bilious; (b) 
sanguinous; (c) a nervous; (d) a lymphatic temperament. 

(a) Large, long in proportion to breadth, angular, deep yellow, 
(b) Well formed, convex labial surface, slightly longer than wide, cream 
color, (c) Length greater than breadth, sharp cusps, bluish-white, 
translucent, (d) Large, broad, poorly shaped, dull, grayish-white. 

What relation in regard to length should (a) the upper teeth 
bear to the upper lip ; (b) the lower teeth bear to the lower lip? 

(a) The upper teeth should show slightly below the upper lip when 
the mouth is opened without raising the lip, and (b) the lower teeth a 
corresponding distance below lower lip, necessitating depression of the 
lip to bring them into view. 

State some of the changes in position, form, and color of the 
teeth that occur in a natural denture with advancing years. 

The teeth become darker in shade — yellowish, sometimes brown. 
They elongate, the gums recede, the cusps become flattened from abra- 
sion. The anterior teeth frequently tend to protrude due to lack of 
support in the sockets caused by absorption of alveolus. 



360 PROSTHETIC DENTISTRY 

What general principles should be observed in arranging 
artificial teeth for an edentulous mouth? 

The expression should be restored and the articulation be perfect, 
heaviest occlusion being at the bicuspids and first molars. The teeth 
should be over the median line of the ridge. 

Give the normal occlusion of the teeth. 

The buccal cusps of the posterior and cutting edges of the anterior 
superior teeth overlap the lower. Each tooth, with the exception of the 
inferior centrals, articulates with two teeth in the opposing jaw, the supe- 
rior central with inferior central and lateral, superior lateral with inferior 
lateral and canine, and so on to the end of the set. 

When would you arrange the teeth of an upper plate to 
occlude directly on the cutting edges of the lower teeth? 

In case of a very short bite, as usually found in aged persons, the 
teeth should be ground flat on the edges and placed edge to edge. The 
posterior teeth ground flat and roughened. 

In full dentures, are the upper or lower teeth first arranged 
on the model? Give the general arrangement. 

The lower incisors are first arranged, followed by the upper incisors. 
Then lower cuspids and upper cuspids, and so on. The upper centrals 
and laterals should incline toward the median line, the cuspids, bicuspids, 
and molars should be nearly perpendicular with the long axis of the ridge 
and over the median line. The upper anterior teeth should slightly 
overlap the lower. The compensating curve, starting with the lower 
centrals, should be depressed as we near the bicuspids, rising again with 
each succeeding molar. 

What relation should the artificial teeth bear to the alveolar 
ridge? 

They should be as nearly as possible over the median line of the 
ridge. 

With a protruding jaw, how far toward the tongue may the 
lower teeth be placed? What relation must they bear to the 
alveolar ridge? 

They should never be placed posterior to the center of the alveolar 
ridge, but as near the center as possible. 

How should faulty articulation of artificial teeth be cor= 
rected? 

If the fault is not great its location may be determined by having 
the patient bite on a piece of carbon paper, grinding off the points of too 
great occlusion. If too much grinding is necessary, the tooth may be 
heated and removed, the socket burred out and the tooth waxed in the 
socket. The correct articulation being obtained, the case is flasked, the 
wax removed and replaced with rubber. The whole case is vulcanized. 
If many teeth are out of proper occlusion, the case should be remade. 



DENTAL PLATES 36 1 

Describe the Bonwill articulator. 

It consists of a hinged cast base into which two heavy wire bows fit, 
being retained with set screws. The upper bow is smaller than the 
lower. The hinge in the base is in the form of a slot at each side, back of 
which is a spring. The slot allows almost the same motion as in the path 
of a natural condyle, the springs acting as muscles to bring the parts back 
to alignment. The front and back and lateral motions resemble closely 
those of the human mandible. 

When a vulcanite upper plate cracks, why does the crack 
usually occur near the median line? 

It is due to several causes, i. Placing the molars too far outside the 
median line of ridge. 2. Thinness of vulcanite over vacuum chamber. 
3. Too great pressure on a hard palatal ridge. 

Name the various materials used as a base for artificial 
dentures. 

Rubber, silver, gold, aluminum, celluloid. Platinum is used as a 
base for continuous porcelain gum work. 

Name the relative advantages of the different materials used 
as a base for artificial dentures. 

Vulcanite is the easiest and quickest of manipulation and possibly can 
be more closely adapted to the surfaces. It is also easily changed if too 
large or too small and readily repaired. 

Gold is less irritating to the mucous membrane than vulcanite, being 
a better conductor of heat. It is also stronger. 

Platinum with continuous gum is ideal as regards conductivity, 
appearance and hygienic cleanliness, but is heavy and requires stronger 
suction. 

Fusible metal is valuable in lower dentures as a base where weight is 
necessary to keep the denture in position. 

Celluloid is light and can be given a very natural appearance, but is 
easily warped and frequently has a disagreeable taste. 

Where and how is crude rubber obtained? 

Crude rubber is a milky fluid obtained by tapping the rubber tree 
(Siphonia elastica). Habitat — South America, Mexico, and the East 
Indies. 

Name the principal solvents of rubber. 

Chloroform, ether, kerosene, and the essential oils. 

What is the substance known as vulcanite? 

Rubber to which sulfur has been added and subjected to heat under 
pressure. 

State the proportions of caoutchouc and sulfur used in 
making vulcanizable rubber for dental plates. 

Caoutchouc 48 parts, sulphur 24 parts. (American Text-Book). 



362 PROSTHETIC DENTISTRY 

At what degree of heat and how long should a rubber denture 
be vulcanized in order that the best results may be obtained? 

320 F. for fifty-five minutes. 

What will be the effect on a rubber plate if it is vulcanized for 
twenty=four hours at 320° F.? 

It will be very hard and brittle and of a dark color. 

Describe the difference in texture of rubber when vulcanized 
between plain plaster surfaces and between metal surfaces 
under pressure. 

The surface in the first instance would be porous, rough, and the 
plate brittle. In the second instance, hard, dense and tough, due to the 
retention of the sulfur which produces these properties in vulcanite. 

State the advantages of using a tin model for vulcanite work. 
Describe the process of making such a model. 

The sulfur is retained in almost its correct proportion to the caoutch- 
ouc during vulcanization, rendering the vulcanite hard, dense and horn- 
like. The tin leaves the surface of the vulcanite highly polished. 

Stetser, of Philadelphia, has devised a system of casting block tin 
models. The impression is taken in investment material and a thin, 
even layer of paraffin painted over the surface of the impression. Several 
sprue wires are adjusted to meet at a common point and fresh invest- 
ment poured in, filling the impression, which is flasked in a special flask 
designed for the purpose. The sprues are now removed and the flask 
heated to dispel the wax. Block tin is forced in by the pressure method 
of casting. When cool, the investment is carefully removed and plaster 
poured into the tin shell to strengthen it. By this method a hard metallic 
surface is obtained, the thinness allowing of easier separation from the 
vulcanite than in the case of a solid tin model. 

What is the coloring pigment in (a) red vulcanite; (b) black 
vulcanite ; (c) pink vulcanite? 

(a) Vermilion, (b) ivory black, (c) oxid of zinc and vermilion. 

Is a gold lining in a vulcanite plate beneficial? Explain. 

Yes; it will overcome to a certain extent the irritation of the rubber 
plate. 

How may an old plate be lined with gold? 

The palatal surface is roughened with a sharp instrument. A sticky 
solution of rubber in naptha is painted over the roughened surface and 
strips of No. 60 gold foil burnished to place with a rubber eraser. The 
strips should overlap and be free from wrinkles. The case is vulcanized 
for a half hour. 

What causes the tissues to inflame under a rubber plate? 

It is caused by the retention of heat under plate, due to the non-con- 
ductivity of the vulcanite, and also by the absorption and subsequent fer- 
mentation of food in the surface of the vulcanite. Some authorities 
claim an irritating effect is produced by the vermilion of red rubber. 






DENTAL PLATES 363 

How may vulcanite be bleached? 

By placing the vulcanite in 95 per cent, alcohol and allowing the sun's 
rays to fall on it. 

State the reasons for using red, black, pink rubber. 

The body of plate is made of red rubber because it is stronger than pink. 
Pink is used for the gum portion, because of its more natural appearance. 
Black rubber is denser, less absorbent than red and therefore less 
irritating to the mucous membrane. If vermilion is irritating, black 
rubber should be substituted. 

State the method of facing a black rubber plate with pink 
rubber by vulcanizing once. 

The case is flasked as usual. Strips of pink rubber are placed above 
the necks of the teeth to the edge of the rim. Small pieces of pink are 
carefully packed between the teeth. A piece of pink rubber is cut to fit 
the palatal portion, adapting it closely to all the teeth and the pink rubber. 
A sheet of black rubber is now stretched to make it thinner, cut to shape 
and pressed down over all the pink rubber. Wet holland cloth is placed 
over the rubber and the flask closed, heated and tightened, after which it is 
opened and a roll of black rubber placed around the line of union of pink 
and black rubber. The flask is closed and the case vulcanized, finished 
and polished as usual. 

Can rubber be vulcanized in direct contact with silver? 
Give explanation. 

Rubber will not vulcanize in contact with silver because of the 
marked affinity sulfur has for silver. The sulfur will leave the rubber 
and be deposited on the silver, preventing vulcanization. 

State a method of treating silver so that rubber can be vul- 
canized in contact with it. 

The surface of the silver should be coated with tin or gold. 

What is weighted rubber, and where is its use indicated? 

Vulcanizable rubber containing tin filings. It is used for lower 
dentures where great resorption of alveoli has taken place and weight is 
necessary to retain the plate in position. 

Describe the method of constructing an artificial denture on 
a vulcanite base. 

A plaster impression is obtained, from which in turn a model of 
plaster is made. The air chamber form is cut from a piece of tin and 
secured on the model with pins. A base plate of guttapercha is con- 
formed to the model and trimmed. Rolls of beeswax are placed over 
the ridge and trimmed to approximate the fulness and length of teeth. 
The base plate is now placed in the mouth and the bite, fulness of gum 
and articulation of antagonizing teeth determined as well as the high and 
low lip line and median line. The base plate with bite is returned to 
model. The model is mounted on articulator, and antagonizing model 
run in plaster. The teeth are now arranged in wax on the base plate, 
articulating with antagonizing teeth, and the wax trimmed and carved 



364 PROSTHETIC DENTISTRY 

to the form the finished plate is to have. The model with wax plate is 
now removed from articulator, trimmed, placed in flask, and soft plaster 
run around the model to the level of the edge of the wax plate. When 
hard, the plaster is varnished, the upper half of flask placed in position 
and filled with soft plaster. When the plaster has set, the flask is heated 
in boiling water, the upper and lower halves separated and the wax 
removed. A sheet of red rubber is placed over the palatine surface and 
small pieces packed around the pins. Pink rubber is placed between 
the teeth, extending as far as the edge of the plate. Vents are now cut, 
the flask tightly closed with bolts and nuts, and placed in the vulcanizer, 
which should be two-thirds full of water. The vulcanizer is now closed 
and heated to a temperature of 320 F. and maintained at this temper- 
ature for fifty-five minutes. The case is cooled gradually, opened and 
the plate removed, after which it is washed, filed, scraped and polished 
with pumice and chalk. 

Describe a method of producing a very thin and rough 
vulcanite plate, both surfaces of which will be nearly finished 
when removed from the flask. 

Before conforming wax to the model, No. 60 tin foil is burnished 
over the entire surface covered by the wax, being careful to obtain per- 
fect adaptation and to avoid wrinkles. The wax base is now moulded 
over the tin foil and scraped as thin as it is desired that the vulcanite 
should be. A piece of No. 30 tin foil that has been previously burnished 
over the palatine surface of the model to obtain a reproduction of the 
rugae, is coated with a thin film of wax to fill depressions. This is laid 
on the palatine surface of the wax base and gently pressed to place, the 
edges of the foil being turned up to catch in the upper half of the flask. 
No. 30 foil is now burnished over the portion representing the gum 
restoration and the case flasked, packed with rubber and vulcanized in 
the usual way. By this means, a very hard, dense and highly polished 
plate is secured, with an accurate reproduction of the rugae in the natural 
mouth. Littie finishing is necessary. 

What should be the form of the surface of an upper denture 
directly back of the incisors? 

It should follow as nearly as possible the natural curves of the under- 
lying tissues. 

Describe the method of reproducing the rugae in a vul= 
canite plate. State the advantage. 

Before affixing vacuum chamber metal, tin foil is laid over the palatal 
surface of the model and with soft rubber and a burnisher closely adapted 
to the surface. The foil is now removed and hot wax run into the de- 
pressions representing the rugae. After the denture has been waxed and 
invested in the lower half of flask, the foil is fitted to the palatal surface 
and gently pressed to place. Care should be exercised not to injure the 
reproduction of the rugae while adapting the foil. The flasking is now 
completed, the case packed and vulcanized in the usual manner. The 
tin foil being next to the surface, will produce a high polish on the palatal 
surface, requiring no further finishing at this point. The feeling to the 



PLUMPERS 365 

tongue is far more natural and enunciation greatly improved when plates 
are so constructed. 

Give method of polishing the palatal surface of a vul= 
canite plate. 

No frictional polishing should be done on the palatal surface of 
vulcanite. If polish is desired, tin foil should be burnished over the 
model before conforming the wax. This is stripped off after vulcanizing, 
leaving a smooth, hard polished surface. 

What causes dark joints in gum teeth? How can this be 
prevented? 

The entrance of rubber or foreign substances in poorly ground joints. 
Perfect grinding, avoidance of V=shaped joint, and the introduction of 
chlorapercha or thin cement in the joint will overcome this trouble. 

State what causes gum sections to break in the flask. 

Excess of rubber or excess pressure upon closing flask with bolts. 

What part of an upper denture has the greatest influence 
on the expression of the face. 

The fulness of the gum reproduction and the anterior teeth. 

What are plumpers? Where placed? State their use. 

They are smooth projections of vulcanite placed along the buccal and 
labial rim of plate to press the lips and cheeks out, restoring the natural 
fulness. 

How may a gold clasp be attached to a rubber plate? 

A tongue or projection of perforated gold plate is soldered to the 
clasp and imbedded in the wax. It will come from vulcanizer firmly 
held by the vulcanite. 

How would you repair a broken clasp on a rubber plate? 

The broken clasp is removed, burring out the rubber overlying the 
flange and a new clasp constructed, waxed to place and vulcanized. 

Describe a method of replacing a tooth on a vulcanite 
denture by means of fusible metal. 

The vulcanite is cut out, dovetailed and undercut with an engine burr. 
The new tooth is waxed in place. Soft plaster is now placed over the 
labial surface of the tooth and vulcanite gum, to retain tooth in position 
when the wax is removed. Having removed all the wax, fusible metal 
is melted, cooled till it will just run and poured into the space previously 
occupied by the wax. The surface is trimmed flush, smoothed with 
a hot spatula and polished. 

What is the guide for the amount of rubber to be used in 
packing a case? 

Wax is softened, but not melted, when removed from flask and placed 
in a measuring glass half full of water. The height of water is noted 



366 PROSTHETIC DENTISTRY 

and wax removed. Rubber is placed in the water until the water rises 
to the same level as when wax was submerged. A little extra rubber is 
added for surplus. 

Give a method of correcting a warped vulcanite rubber 
plate. 

An impression of the mouth is taken and a model of very hard plaster 
or fusible metal secured from it. The plate is heated until the vulcanite 
is flexible, placed on model and with a heavy, smooth burnisher conformed 
to the model. This process is repeated until the plate fits the new model. 

What is your method of repairing a rubber plate fractured 
through the center? 

The edges of the fracture are held in correct juxtaposition and re- 
tained with hard wax dropped over the crack on the lingual surface. 
The palatal surface is oiled and filled with soft plaster. When plaster 
hardens, the plate is removed and the crack widened with engine burrs or 
file. Dovetails are cut back into the vulcanite on each side of fracture, 
the plate returned to the plaster model and the cut out spaces filled with 
wax flush with the vulcanite. The case is now flasked, separated, 
wax removed, and rubber substituted, after which it is vulcanized and 
finished. 

Describe the method of using "Victoria" or other metal to 
strengthen or reinforce vulcanite partial dentures. 

The " Victoria" metal is cut the desired shape and pressed to con- 
form to the model with the smooth side next to the plaster. The rubber 
is packed against the rough side of the metal, which becomes imbedded 
in the finished plate. When a metal bar is used it is bent to conform 
with the curve of the denture and imbedded in the wax, being invisible 
in the finished plate. 

How may a partial lower plate be strengthened when the 
teeth are scattered? 

If vulcanite, by adding perforated gold plate or "Victoria" metal to 
the vulcanite during the construction of the denture. If gold, by re- 
inforcing the lingual surface with an extra strip of gold soldered to plate. 

What are the essentials, for retention, to be observed in the 
construction of a full denture? 

The adaptation should be perfect, the air chamber well formed and 
placed, and the sides cut down to avoid the muscles when stretched. 

Mention some of the various methods of retaining artificial 
dentures. 

Perfect adaptation, securing atmospheric pressure, which is usually 
increased by a vacuum chamber. By the adaptation of clasps to natural 
teeth. Springs. Force of gravity. 

Describe the Griswold retainer for artificial dentures. 

There are two parts: One the " Spring" is a V=shaped tube of cor- 



RELIEF SPACES AND VACUUM CHAMBERS 367 

rugated metal which is soldered to a crown for one of the natural teeth. 
The other, called the box, is a corrugated piece of metal the same shape 
as the "spring," only slightly larger. The "box" is imbedded in the 
vulcanite, or soldered to the gold, of the artificial denture in such a posi- 
tion that it will tit over the spring when placed in the mouth. The 
corrugations dovetail or interlock, holding the denture in position. 

Explain how an entire upper denture is retained in position. 

Adaptation, causing atmospheric pressure, increased by vacuum 
chamber. 

What is the value of relief spaces as compared with vacuum 
chambers in full upper dentures? 

Relief spaces are less likely to irritate the membrane and the suction 
is more distributed. 

What is the Cleveland vacuum cavity? 

It is a soldered vacuum chamber, the opening in the plate being 
smaller than the cap or covering. 

What relation should the vacuum chamber bear to the center 
of gravity? 

The vacuum chamber should be over the center of gravity. 

How would you find the center of gravity of the palatal 
vault on a model of an edentulous upper jaw? 

By drawing lines from the condyle on each side to the interdental 
space between bicuspids, where they cross on the median line is the 
center of gravity. 

What nerves may suffer from the sharp anterior edge of an 
improperly placed vacuum chamber? 

The nasopalatine. 

Give the composition of celluloid. 

Pyroxylin, camphor, zinc oxid and vermilion. 

Describe the process of constructing an artificial denture on 
a celluloid base. 

The plaster impression is thoroughly dried and a model run of block 
tin. The vacuum chamber having been cut in the impression, the ob- 
verse is produced on the tin model. The bite and arranging of teeth in 
the wax are the same as for vulcanite, except that the wax used is com- 
bined with paraffine. The wax is carved to represent the natural gum 
and rugae and made smooth over a spirit lamp, after which No. 60 tin 
foil is burnished over the entire surface of the wax. The model is now 
invested in the shallow half of a special flask for celluloid work. When 
the plaster sets it is coated with a solution of soap, and the deep section 
adjusted and filled with soft plaster. After the plaster has set the flask 
is heated and opened, and the wax thoroughly removed with a stream of 
hot water. A groove is now cut in the plaster surrounding the model to 



368 PROSTHETIC DENTISTRY 

take up the surplus celluloid. A blank of celluloid is now softened in 
boiling water and pressed into the mould and over the imbedded teeth. 
The flask is now closed and placed in the specially designed machine, 
so constructed that the flask is in a tank which is heated, keeping a hot 
moist air around the flask. As the heat increases the pressure is brought 
to bear on the flask until it is entirely closed. The case is now allowed 
to cool slowly, when flask is separated, the plate removed from the plaster, 
the tin foil stripped off and surplus trimmed away, when it is polished as 
a rubber plate. 

Describe the method of constructing a lower artificial 
denture made by the cheoplastic process. 

The model is composed of equal parts of marble dust and plaster. The 
same procedure as for a vulcanite plate is observed until ready to flask. 
The flask is of special design, being larger and flatter than a vulcanite 
flask and with large perforations in the top and bottom. The case is 
invested in the usual manner in this flask, using marble dust and plaster, 
equal parts, and vents are cut from the heels of the plate to the outside of 
flask. The wax being removed, the flask is now thoroughly dried over a 
low flame and the two halves clamped together. The fusible metal is 
now melted and poured in one vent until it shows in the opposite vent. 
The case is cooled slowly, removed from flask, filed, sand-papered, and 
polished as a rubber plate. 

Mention the three principal ingredients used in manufacture 
ing teeth, and state which one gives the translucency and lifelike 
appearance. 

Silex, feldspar and kaolin. The feldspar forms the enamel and, with 
the aid of the silex, gives the translucency. 

What metal is used as a coloring agent to produce the 
grayish=blue tint of the enamei in artificial teeth? 

Platinum. 

What color is produced by titanium in porcelain enamel? 

Yellow. 

What is purple of Cassius and for what is it used in porcelain? 

The combined oxid of tin and gold. It produces the pink gum 
color. 

What are the relative merits of plain teeth and gum sec= 
tions? State where each should be used. 

Plain teeth should be used when the anteriors are ground to fit the 
natural gum without rubber restitution and where the lip cannot be 
raised above the necks of the teeth. Because of their more natural ap- 
pearance, gum sections are used where there has been great resorption or 
where the gums are much exposed on talking or laughing. 

Describe the difference between long bite and short bite 
teeth. Mention cases where each would be appropriate. 

The difference consists in the relative length from ridge lap to cutting 



PIN TEETH AND DIATORIC III Hi 369 

edge on the palatal or lingual surface. Long bite teeth for a short ridge 
and long lip, or where considerable overbite is indicated. Short bite 
teeth for a long ridge and short lip. 

Which are the longer, the buccal or the palatal cusps of the 
upper bicuspids and molars? 

The buccal cusps. 

Why is platinum used for pins in teeth? 

The co-efficient of expansion is nearly the same in platinum and 
porcelain, reducing the chance of fracture in the manufacture. Also the 
platinum is unaffected by the fluids of the mouth. 

What are the advantages of counter=sunk pin teeth? 

They conform more closely to shape of the natural teeth, making 
them feel natural to the tongue and presenting a more natural appear- 
ance to the eye. 

Where can pinless or diatoric teeth be advantageously used? 

Where little grinding of occlusal surface is necessary and the teeth 
do not require close adaptation to the gum. If much ground, the hollow 
center will be exposed and, if set too close to the gum, insufficient attach- 
ment of rubber is afforded. 

Mention some of the uses of tube teeth in prosthetic dentistry. 

They may be used as single crowns, for dummies in bridge work or 
in place of gold backed facings in gold plate work. 

What are English tube teeth? Describe a method of attach^ 
ing them to a gold plate. 

English tube teeth are a class of plain teeth made with a platinum 
tube baked in the porcelain, extending through the center of the tooth 
and corresponding to its long axis. The English tube teeth are attached 
to a gold plate by first grinding them to fit the position they are desired to 
occupy. They are held in place by means of hard wax. A marking- 
wire, tipped with vermilion paint, is passed through the tube of each 
tooth until it touches the plate, marking the place at which the holes are 
to be drilled to receive the pins. The teeth are removed and the holes 
drilled. Gold pin wire of the desired length is cut, and the end to be 
inserted into the drilled hole is tapered so as to fit tight and project through 
on the palatal surface. The tapered end of the pin and pin hole are then 
boraxed and the pin soldered to the plate. The teeth are then placed 
on their respective pins and the final adjustment made. Previous to 
attaching the teeth to the pins, shallow grooves are made in the latter with 
a fine file. The teeth are thoroughly cleansed, dried and replaced on the 
pins. In a small porcelain receptacle sulfur is melted, and with a wire 
spatula the sulfur is conveyed to the plate, which is kept heated by 
holding it with the pliers over a burner. The sulfur runs under the 
teeth and along the pins. When cool, it sets hard and the teeth are 
immovable. (American Text-book of Prosthetic Dentistry.) 
24 



370 PROSTHETIC DENTISTRY 

Many investment compounds contain silicates in the form 
of sand, etc. What may occur to the teeth if, in soldering, 
borax is used and unites with the silicates? 

The teeth would be checked or cracked — possibly fused to the in- 
vestment. 

Give a formula for a 20 carat gold clasp metal. 

Gold 20 parts 

Silver 2 parts 

Copper and Platinum, of each 1 part 

Give a formula for a 22 carat solder. 

Pure gold, 22 parts; copper, 1 part; silver, 3/4 of one part; zinc, 1/4 of 
one part. 

Give the fusing point of gold, silver, copper. 

Gold, 2016 F.; silver, 1873 F.; copper, 2000 F. 

Give the formula for 20 carat gold plate. 

Gold, 20 dwts.; copper, 2 dwts.; silver, 2 dwts. 

What effect has zinc in gold solder? 

It renders it less malleable but lowers 'the fusing point, enabling the 
solder to flow more readily. 

What would be the effect of placing a piece of lead on a gold 
plate during the process of annealing? 

It would be incorporated with the gold, destroying the working 
qualities, and, if sufficient heat were applied, a hole would be burnt, owing 
to the lead reducing the fusing point of the gold. 

Give the composition of spelter solder sometimes used in the 
preparation of gold solder for the purpose of reducing the fusing 
point. 

An alloy of zinc and copper, being richer in zinc than is the alloy 
known as brass and consequently lower fusing. 

In soldering a case of repair, full or partial denture, what risk 
is added and what special precaution is necessary? 

The risk of loosening the joints already soldered. It is necessary to 
use a solder of lower carat than usual to avoid fusing the old solder, and to 
have all parts covered except where the repair is to be made. 

Why is flux used? 

A flux cleanses the surface of oxids, permitting the easy flow and 
adherence of the solder. 

What special quality has borax which makes it such an 
admirable flux in soldering and melting metals? 

When fused it becomes glass and dissolves the metallic oxids. 



SOLDERING 371 

What is the proper method of directing the flow of the solder? 

The proper application of the ilux and manipulation of the blow- 
pipe flame. A piece of iron wire may be used to apply more flux and to 
coax the solder over a narrow gap. 

How is gold solder confined to the desired surface? 

By coating the contiguous surfaces with a thin paste of whiting. 

Describe the process of autogenous soldering. 

Autogenous soldering or sweating is accomplished by bringing the 
surfaces to be soldered in apposition and heating just enough to fuse the 
surface, when the piece is removed from the flame and suddenly chilled. 
The parts must be of like metal and perfectly clean. Borax is sometimes 
used as a flux. 

Can you solder 18 carat plate with 18 carat solder? Explain. 

You can. The alloy in the solder being lower fusing, the solder will 
fuse at a lower temperature than the plate, although both may be said to 
be of the same fineness. 

Describe the process of sweating together two pieces of gold 
plate of the same degree of fineness. 

The two pieces are brought into absolute contact and the entire 
portion to be sweated is heated with a large brush flame in the blow pipe. 
The pieces should be heated just enough to cause the surfaces to fuse, 
uniting the two. 

What gauge of gold plate is used for an upper denture? What 
for a lower? State carat. 

Eighteen or twenty carat gold plate of twenty-six gauge for the upper, 
and thirty gauge for the lower. Two thicknesses are usually used for 
the lower. 

Describe the construction of a gold plate with rubber attach= 
ment. 

The base is swaged, air chamber cut and soldered, and bite obtained 
as described for a soldered denture. The rim is of square or triangular 
wire and is continued around the palatal border of the alveolar ridge as a 
finish for the vulcanite. Loops of gold are soldered in several places 
along the alveolar ridge. The teeth are now waxed in proper position 
and articulation, the case flasked, packed with rubber and vulcanized. 
The plate is finished and polished in the same manner as one of vulcanite, 
the gold receiving a final polish of rouge. 

Give two methods of swaging a metal plate. 

A tin foil pattern is made and the plate cut to pattern, annealed, 
placed on the die, and the palatal portion roughly adapted with a horn 
mallet. The metal is again annealed, returned to die and a counter-die 
covering only the palatal portion placed over it. A few blows from a 
heavy mallet will adapt the metal on the palatal surface, after which a 
horn mallet is used to bring it over the buccal and lingual surfaces. The 



372 PROSTHETIC DENTISTRY 

plate after annealing is now brought to accurate adaptation with full 
sized counter-dies, care being exercised to eliminate wrinkles with horn 
mallet. 

Another method is to partially adapt plate with die and counter-die 
after which it is laid on the plaster model and placed in the bottom of an 
iron cylinder. Fine shot is poured into the cylinder until model and 
plate are completely covered. The iron plunger is placed in position 
and heavy blows administered, bringing the plate into accurate adaptation 
to the model. 

Describe a method of constructing a partial lower denture 
of gold, the teeth of which are soldered to the plate, the six 
anterior natural teeth being in the mouth. 

Dies and counter-dies are made and tin foil pressed over die to obtain 
pattern. The pattern is laid on a sheet of 18 carat, 30 gauge gold plate, 
and two forms cut out. The gold is annealed and adapted to the die 
with a horn mallet, after which it is again annealed and brought to correct 
adaptation with the counter-die. The two plates are now swaged to- 
gether, removed, cleaned with sulfuric acid, the opposing surfaces 
coated with flux, returned to die and swaged together again. They are 
now soldered together and the portion which covered the backs of an- 
terior teeth cut to fit the necks of the teeth. Two rolls of wax are now 
placed in position and the bite obtained. The teeth are ground to place, 
backed and attached with hard wax, the case invested in sand and plaster, 
heated and soldered. After soldering the case is allowed to cool slowly 
when it is washed, placed in hot sulfuric acid to remove oxid, smoothed 
with fine stones and polished with pumice, followed by rouge. 

Describe the method of constructing an artificial denture on 
a gold base, using single gum teeth. 

Accurate dies and counter-dies are obtained and a sheet of twenty-six 
gauge plate annealed and swaged to fit die. An opening is cut for the 
vacuum chamber, and a piece of plate a little larger than opening is 
swaged over the vacuum chamber form and soldered in position. A rim is 
soldered on, the bite taken, models articulated, and the gum blocks ground 
to perfect joints, the teeth being properly articulated at the same time. 
Two shallow holes are now cut in both sides of the plaster base, and a 
thick wall of plaster built around the labial surfaces of the teeth, extending 
to the edge of the model. When hard, this matrix is divided at the median 
line with a sharp knife and the two halves removed from the plate and 
model. The teeth are removed from the wax and placed in their places 
in the plaster matrices, the wax removed from the gold base and the 
matrices, with teeth, adjusted to the base. The teeth are now removed one 
by one and backed with gold, the backing filed to fit the undulation of the 
gold base and the tooth returned to its place in the matrix. The backings 
are all tacked to the plate with hard wax, the matrices removed and the 
plate invested in sand and plaster, leaving the portion covered by the 
hard wax exposed. When investment is dry, the hard wax is removed, 
and liquid flux carefully painted over the joints formed by backing on plate 
and between backings. The case is now heated, and with a blow-pipe 
solder is caused to flow over all these surfaces. When cool, the investment 



GOLD AND SILVER PLATES 373 

is removed, the plate immersed in a bath of sulfuric acid, removed, 
washed, and polished with pumice, followed by fine chalk and finally 
rouge. 

Describe the method of forming a rim of a full upper gold 
plate. 

Two strips of gold plate are cut, 3/16 of an inch wide, and long 
enough to reach from the median line around the edge to the heel of the 
plate. The end of one strip is tacked with gold solder to the edge of the 
plate at the median line. The strip is now adjusted to the edge with 
pliers and soldered, one section at a time, progressing until the entire 
strip is attached. The other strip is fastened to the opposite side in like 
manner. If it is desired to have rim extend in a horseshoe on the palatal 
surface, the strips are cut longer or pieced and the soldering continued 
as before. 

State the precautions that should be taken to prevent gold 
plate from cracking during swaging. 

The gold should be frequently annealed and over-annealing, as well 
as too rapid swaging, should be avoided. 

What is the result of over=annealing gold or silver plate? 

The metal will crack during swaging on account of crystallization 
caused by fusing the surface of the metal. 

What causes gold and silver plates to warp while soldering? 
How can it be prevented? 

It is caused by the contraction of the solder and insufficient invest- 
ment. It can be prevented by having the plate well covered with invest- 
ment. It is necessary to avoid too heavy investment, however, as warping 
may result from the contraction of a large bulk of material when cooling. 

What method should be used to correct a slightly warped 
plate with teeth in order to fit a plaster model? 

The plate should be held firmly on the plaster model and the warped 
portion brought to position with a few careful blows, using a horn mallet. 

Give a method of strengthening an upper or lower gold plate 
behind anterior teeth. 

On a lower plate an extra layer of gold the width of plate is swaged 
and soldered on the lingual surface, extending to the bicuspid tooth on 
each side. The upper is reinforced in the same manner, the width of 
gold being a little short of the edge of the vacuum chamber. 

What is the method of repairing a cracked plate of gold? 

The plate is cleansed in hot sulfuric acid and a strip of gold foil 
burnished on the palatal surface the length of crack. The crack is 
painted with borax and solder flowed the length of crack. If the plate 
has cracked owing to the gold being too thin, a strip of 30 gauge plate 
may be burnished on the lingual surface over crack before soldering. 
The plate is finished with stones and polished. 



374 PROSTHETIC DENTISTRY 

What kind of a denture should be constructed for a patient 
whose superior canines and second molars are in position. 

A horseshoe plate with a clasp on each molar. 

Express in carats the fineness of American gold coin. 

21.6 carats. 

Give a formula for clasp gold. 

Gold (24 carat) 20 dwts. 

Copper 2 dwts. 

Silver and platinum, of each 1 dwt 

What is the difference between platinous gold and platinized 
gold? 

Platinous gold is an alloy of gold and platinum. Platinized gold is 
gold plate surfaced with platinum. 

Give a method of making a gold clasp. State thickness of 
the metal used. 

A pattern of tin foil or thin lead is fitted to the tooth model, from which 
is cut a duplicate in 24 gauge clasp metal. The metal is annealed and 
contoured to the model with round-nosed pliers. The edges and corners 
are rounded off with fine gold files. 

Give method of attaching a clasp to a gold plate. 

The plate is placed in the mouth and the clamp adjusted to the tooth. 
An impression is then taken of the clamp and the contiguous part of the 
plate. The plate and clasp are removed, the clasp attached with hard 
wax, the impression removed, and the case invested and soldered. 

Should a gold clasp be used about a tooth containing a large 
amalgam filling? 

It is unwise to do so, as in most instances galvanic currents will be 
established, which, if not actually harmful to the pulp, are annoying to 
the wearer. 

How can an accurately fitting clasp be constructed by the 
cast metal process? What material is suitable for such a clasp? 

The model of the tooth to be clasped is oiled and a strip of inlay wax 
warmed and adapted to the tooth. With a sharp instrument the wax 
is carved to the shape of the desired clasp, a sprue wire affixed and the 
wax carefully removed from the model. The final manipulation is the 
same as for a cast gold inlay. Platinous gold may be used for a cast 
clasp. 

Mention some of the ingredients of " moldine." 

French clay and glycerin. 

Of what is Babitt metal composed? 

Nine parts tin and ten parts copper. 



DIES AND COUNT EH DIES 375 

Mention the ingredients of an impression material into which 
a fusible metal may be safely poured. 

Plaster of Paris and marble dust. The impression should be bone 
dry. 

Define die, counter=die. Mention best metals for each. 

A die is a metal model — the obverse. A counter-die is a thick matrix 
of the metal model — the reverse. Zinc for die and lead for counter-die 
seem to give best service. 

Give the essential properties of metals used for dies. 

They must be low fusing, noncontractile and hard enough to stand 
the stress of swaging. 

Give the constituents of Spence metal. What is its melting 
point and what are its dental uses? 

The principal ingredient of Spence metal is sulfur, which gives the 
alloy its low fusing point (about 160 F.). It is used for dies of individual 
teeth or cavities. Owing to its low melting point it may be poured into a 
plaster or dentallac impression, and yet it becomes hard enough to resist 
swaging when cold. 

Describe a method of obtaining a correct die from a lower 
model that has several anterior teeth standing, the jaw very 
much undercut lingually below the neck of the teeth. 

The lingual undercuts are overcome by means of two cores meeting 
at the median line. The labial surface of the model should present a 
straight line from the cutting edges of the teeth slanting out to the base. 
The cores in position, the mould is made as usual, the cores removed, 
from model, placed in mould, and the metal run. 

Describe the method for making and using cores to obtain 
accurate moulds from models with deep undercuts. 

The undercut in the model is oiled and filled flush with a soft mix of 
equal parts plaster and marble dust. When hard, this is removed from 
model and dried. It is then replaced on the model, and the mould made as 
usual. The core is detached from model and placed in the mould, after 
which the metal is run. 

Describe a Hawes moulding flask and state why it is used. 

It consists of two iron rings about eight inches in diameter. One 
ring, the lower, is divided into three movable sections, the joints prolonged 
toward the center and joined with pins. It is used to form moulds for 
dies with undercuts. * 

State the uses of aluminum in dentistry. Describe the 
method of annealing. 

It is used as a base for artificial dentures and for model shell crowns. 
The sheet is placed on the stove over flame, and a piece of soft wood 
(match stick) placed on it. When the heat is sufficient to char the wood, 
the aluminum is annealed. Further heat would burn the metal. 



376 PROSTHETIC DENTISTRY 

State two methods of using aluminum in the construction of 
artificial dentures. 

By swaging aluminum on a metal die. By casting. 

Describe the method of making an upper denture on swaged 
aluminum, the teeth to be attached with rubber. 

Accurate dies and counter-dies are made. Twenty gauge aluminum 
plate is annealed, cut to pattern and swaged in the usual manner. The 
rim is trimmed and slightly turned or curled up all the way around the 
plate except across the back. The surface over the alveolar ridge is 
pricked with a sharp pointed instrument to afford attachment for the 
rubber. The wax is now mounted on the base, the bite obtained, teeth 
set up and the case flasked and vulcanized in the same manner as for 
rubber alone. The metal is polished with fine rouge on a felt cone. 

What base for an artificial denture do you consider hygien= 
ically the best and why? 

Continuous porcelain gum on platinum base. The platinum is nou- 
irritating to the mucous membrane and, the porcelain being nonporons, 
absolute cleanliness is easily maintained. 

How would you solder platinum? 

By using pure gold as a solder, or gold and platinum alloy. 

Give the formula of platinum solder. 

Pure gold may be used, or gold 95 parts, platinum 5 parts. 

What is the fusing point of platinum? 

3500° F. 

What combination of metals makes a good clasp for a con= 
tinuous gum partial denture? 

An alloy of platinum and iridium. 

What frit is used to produce porcelain=gum enamel? 

Potassium carbonate, borax, feldspar, quartz and purple of Cassius. 

Mention the material that is used as a flux for reducing the 
fusing point of porcelain enamels. 

A combination of silica, borax, and carbonate of potassium. 

Of what value is kaolin in porcelain bodies? 

It imparts plasticity and strength to the porcelain body. 

About what degree of heat is required to fuse porcelain in 
continuous gum work? 

Depending on the porcelain used — from 2100 F. to 2600 F. 

In continuous gum or other work in which porcelain is used, 
what is the cause of the porosity sometimes found on breaking 
the piece? 

Overf using; fusing at too high a temperature; fusing before por- 
celain is bone dry; incorporation of air in porcelain while mixing. 



CONTINUOUS GUM DENTURE 377 

What are the advantages of continuous gum? 

Cleanliness, durability, and life-like appearance. 

Describe the method of constructing a continuous gum 
denture. 

The base is constructed in the same manner as a gold plate, substitut- 
ing 29 gauge platinum for the gold. The edge is reinforced with half- 
round platinum wire, and a strip of 29 gauge platinum plate, 1/8 inch 
wide, soldered to the back edge on the lingual surface. The platinum 
strip is slightly raised on the inner edge to permit the porcelain to run 
under it. The bite is taken and models articulated. The teeth used 
are continuous gum, roots being reproduced, and long platinum pins 
instead of short ones. As each tooth is adjusted, the pins are bent to 
touch the plate and tacked with hard wax. When all are adjusted, the 
case is invested and the pins soldered to the plate with pure gold. The 
plate is now placed in the mouth and the final adjustment of the teeth 
made. The porcelain body is now mixed with gum arabic and water and 
packed around the roots and over the palatal portion of the plate. With 
a thin bladed knife, fine cuts are made through the body from the edge 
of plate between each tooth and across the palatal portion, to prevent 
warping during contraction of the body while baking. The case is 
thoroughly dried, placed in muffle, biscuited, and allowed to remain in 
muffle till cool, after the current is turned off. When cool, the cracks 
are filled flush with body and the gum enamel applied, moulding it care- 
fully and stippling the gum. Passing a gnurled instrument over the edge 
of the plate will bring the moisture to the surface when it is absorbed with 
blotting paper. The case is dried again and placed in the muffle. The 
heat is increased till greater than for the body and the case left in till 
glazed, when the heat is turned off and the plate left to cool slowly. 
The metal surfaces are polished with pumice, followed with chalk. 

What is meant by "stippling?" 

Dotting the surface of the gum with minute pits to give a natural 
appearance. In porcelain work this is done in the enamel, in vulcanite, 
in the overlying tin foil. 

State the method of replacing a tooth broken from a denture 
of continuous gum. 

The remaining portion of the broken tooth is ground out with carbo- 
rundum stones to a sufficient depth and breadth to permit the adjustment 
of a new tooth. Fresh body is packed around the tooth and biscuited. 
When cool, the enamel is applied and burnt to a glaze. 

Describe the construction of an upper denture of porcelain. 

Two casts are taken from a plaster impression of the mouth and a 
thin lead plate burnished to one of the casts. Softened beeswax is then 
placed on the ridge and the articulation obtained in the usual way. The 
cast and the articulating model must then be enlarged to allow for the 
contraction of the porcelain in burning. To accomplish this, the cast 
and articulation are divided into four sections with a thin saw. The 
first division is made at the center, along the median line to the back of 



378 PROSTHETIC DENTISTRY 

the cast; the second division, back of where the cuspid teeth are located. 
Before cutting the cast, the bottom should be made smooth and level. 
After the case has been divided, the sections are placed together, leaving 
a space of a quarter of an inch between each. This is filled with freshly 
mixed plaster, the sections being held in position by wax. When the 
plaster is hard, a new lead plate is cut and burnished to the case. The 
sections of the wax articulating model are placed on the enlarged cast and 
the interspaces filled with melted wax; thus the model conforms to the size 
of the enlarged cast. An outside wall is now made for molding the body. 
This is done by bending a piece of tin around the front and sides of the 
cast (with the wax articulating model on it) to get the correct curve. The 
tin is then removed one-fourth of an inch from the cast in front and at 
the sides, and is sustained in this position until freshly mixed plaster 
is poured into the space between the cast and tin. This wall is then 
trimmed; after the removal of the wax, the wall should be lined with 
tin foil. 

The parts are then thoroughly cleansed for moulding. The lead 
plate and inside of the wall should be oiled, and a piece of body laid on the 
lead plate before the wall is put in place. This is worked over the edge 
of the gum to the limit of the plate line. The wall is then put in place 
and the body packed up against it. The rest of the body is pressed down 
against the surface of the lead plate, extending back as far as the plate is 
to be carried. The body is then dried sufficiently to be carved into shape. 
This is done roughly on the cast and, when reduced to the proper thick- 
ness, it is dried and biscuit baked. When the case is cool, the enamel is 
applied and the final carving and gumming completed. It is then dried, 
placed in the muffle and burned until fully glazed. When cool, it is 
ground to fit the original cast, which was left unenlarged. (American 
System of Dentistry). 

What are the requisites of a crown? 

It should prevent further decay, restore the shape and occlusion of the 
tooth and not be irritating to the surrounding tissue. 

State what procedure is necessary to secure a natural appear= 
ing crown in a case where, from extensive caries, the adjacent 
teeth have moved somewhat together, thereby reducing the 
normal space at the cutting edge. 

The adjacent teeth should be separated. This may be accomplished 
by wrapping the tooth to be crowned with ligature, by forcing gutta- 
percha between the teeth in sufficient quantity to receive the force of 
mastication, and, if the root to be crowned is badly broken, by tightly fit- 
ting a square wedge of orange wood in the space and allowing it to remain 
in place for several days. When wet, the wood will swell enough to widen 
the space sufficiently. 

Describe a method of constructing a bicuspid jacket crown 
with a porcelain facing fused to it. 

A band of 30 gauge platinum is made and fitted to the root. The 
length of this band should be a little short of occlusion. A piece of iridio- 
platinum is contoured to form a cusp and soldered to the band. The 



crowns 379 

labial surface of band is now ground out, and a facing ground to fit the 
opening, the edges of which are left rough and ragged. The facing is 
held in place and the mixed porcelain packed around it, inside and out, 
dried and baked. More porcelain is added to make up for shrinkage, 
and the crown rebaked and brought to a glaze. 

Describe the method of constructing a bicuspid crown with 
a porcelain front for a tooth having a vital pulp. 

A seamless gold cap is constructed and fitted to the root in the usual way. 
The front is ground out, leaving a sixteenth of an inch as a band under the 
gum. The face of the tooth is now ground back at an obtuse angle from 
the gum line to the occlusal surface, care being exercised not to encroach 
on the pulp chamber. A thin porcelain facing of the proper shade is 
ground to fit the opening in cap, backed, forced to place and attached 
with sticky wax. The crown is now removed and the joint soldered. 

State the method of adding a low=fusing porcelain face to a 
gold shell crown. 

The face of the crown is dented in until the entire surface shows a 
concave depression a little over a sixteenth of an inch deep. Several 
perforations are made from the inside, allowing the jagged edges to 
protrude. Low fusing procelain is now mixed, and the concave surface 
restored to contour. The case is dried and baked. More material is 
added to replace that lost through shrinkage, and the crown rebaked and 
polished. 

Describe the Justi removable pin crown. 

It is a manufactured, all porcelain crown with a detached pin. The 
base of the crown is concave and the opening for the pin is in the shape 
of a horseshoe, the heels pointing lingually. There are several undercuts 
or steps in the labial wall of the opening. The pin is of combination 
metal and is shaped to fit the peculiar opening in the porcelain. The 
end intended for introduction into the canal is serrated. 

Describe the construction of a platinum base, porcelain 
crown. 

The root end is ground to a point slightly under the gum margin 
labially, and a sixteenth of an inch above the gum lingually. A band of 
30 gauge platinum is fitted to the root and a flat floor of 36 gauge platinum 
soldered to it. The floor is punctured over the canal and a platinum 
dowel pushed through, attached with hard wax, removed and soldered. 
The dowel should extend at least a sixteenth of an inch on the crown side 
of floor. A cross pin facing is now selected of the proper shade and 
shape, and ground to fit the labial edge of cap. The pins are bent to 
touch the dowel, attached with hard wax, invested and soldered. Pure 
gold is used for solder. The case is now tried in the mouth and the final 
adjustment made; it is then removed, porcelain body mixed and packed 
around dowel and pins, covering the floor, and curving to represent the 
natural labial aspect. The crown is now dried and baked. When cool 
the enamel is applied and burnt to a glaze. 



380 PROSTHETIC DENTISTRY 

Describe the process of making a platinum and porcelain 
crown with porcelain occluding surface. 

A platinum band is adjusted and contoured. The band is cut at 
an angle, leaving a strip one-sixteenth of an inch labially, and high 
enough to clear occlusion by a sixteenth of an inch lingually. A platinum 
pin saddle back tooth is fitted to the band, held in place, and porcelain 
body packed along the joint and over the margins of the platinum Body 
is packed in the interior of the crown flush with the pins, and the crown 
baked. When cool, a layer of porcelain enamel is added to the outside 
margins and the crown glazed. 

What style crown would you use to restore abraded front 
teeth? 

A platinum cap with porcelain face. 

What is the advantage of the Davis crown? 

Its natural appearance due to translucency; wide range of adap- 
tability and ease of repair. 

Describe the Davis crown. State how you would adjust it 
to the root. 

It is a factory made, all-porcelain crown with detached pin. The 
crown has an undercut opening in the base for the reception of the head 
of the pin. The mouth of the opening is countersunk to receive the 
collar or flange on the pin. The base of crown is ground to accurately 
fit the end of root. The canal is reamed to receive pin, which is cemented 
in. The opening in the crown is now filled with soft cement, placed 
over end of pin and forced to position. 

State the process of adapting a Davis crown, using a cast 
gold base. 

The root end is prepared in the usual way, and a notch ground at the 
center of the palatal or lingual edge. The porcelain is ground to an 
approximate fit at the front, sloping up to form a clearance of a sixteenth 
of an inch in the back, and a corresponding notch ground at this point. 
The pin is placed in canal and a small piece of pink wax moulded over 
the end of root and pin. The crown is wet and forced to position, and the 
wax trimmed flush. The crown, pin and wax are removed, the pin and 
wax invested and cast. When cool, the pin and attached gold base are 
cleansed and cemented in place and the crown cemented on pin. Abso- 
lute adaptation is obtained by this method, protecting the end of root from 
decay. The counter-notching of root and porcelain acts as a guide in 
setting and prevents rotation. 

Describe the Bonwill crown and method of its attachment 
to the root. 

The crown is all porcelain with the pin hole through to the occlusal 
surface where a dovetail is formed. The base is concave. The root is 
ground flat and slightly under the gum labially. The canal is enlarged 
and the edges of crown base ground to accurately fit the edges of the root. 
The pin is now cemented at the proper angle, determined by holding crown 



RICHMOND CROWN 381 

in position while cement hardens. Soft amalgam is now placed in con- 
cave base and pin hole, and crown forced on pin and driven to place, after 
which more amalgam is packed around pin, tilling hole flush with occlusal 
surface, and finished off as a filling. 

State which, in your opinion, is the best artificial crown for 
any of the six upper anterior teeth. Give reasons. 

The Richmond crown. In this style of crown all advantages are 
embodied except the naturalness of translucency. There is less danger 
of breakage under the stress of mastication, the root is better protected 
from the fluids of the mouth, greater range of position is possible, and 
the integrity of root is better safeguarded. 

Describe a Richmond crown. 

It consists of a gold band and floor. The floor is pierced by a pin 
fitting into root canal and soldered to floor. A facing is ground to fit 
the labial edge of band, backed with platinum or gold and soldered to 
floor and cap, reproducing the shape of a natural crown. 

Which has the greater translucency, a Richmond crown or an 
all porcelain crown? State the cause of the difference. 

The all porcelain crown. The metal back of the Richmond crown 
prohibits the transmission of light rays, w r hile in the all porcelain the rays 
are practically uninterrupted. 

Give method of preparing root for a Richmond crown. 

The root is ground off to within a sixteenth of an inch of the gum 
and the enamel remaining removed with cleavers. The anterior third 
of root surface is ground at an obtuse angle to a point slightly under the 
gum margin. The canal is enlarged to admit the pin of the desired 
gauge. 

In soldering a Richmond crown, how may the solder be 
drawn to the front so that a perfect joint between the porcelain 
and gold may be obtained? 

The backing should extend over the edge of porcelain, be ground 
thin and burnished tight before waxing tooth in position. The joint 
should be covered with borax paste. After investing and removing 
wax, the borax is mixed thin and coaxed in from the back. Solder is 
now placed in position and heat applied under the investment. The 
labial side heating first, the solder will run through to a perfect joint. 

How would you repair a Richmond crown with a broken 
facing? 

If out of the mouth, the remains of facing are broken away, two holes 
drilled through to admit new pins, and a new facing ground to fit. The 
new facing is placed in position with pins in holes, invested and solder 
flowed into pin holes, retaining facing in correct position. If in the 
mouth, the same procedure except that the ends of the pins are riveted 
and thin cement smeared on pins and facing before forcing into position. 



382 PROSTHETIC DENTISTRY 

Give a method of removing a Richmond crown in order to 
repair a broken facing? 

If guttapercha has been used to set crown, the application of heat 
will render its removal simple. Cemented in place, the band is cut in 
the rear, the cut edges laid back, and the cement between gold and root 
worked out with thin instrument. A strong flat instrument is now intro- 
duced between the root and the gold, grasped with pliers and carefully 
rotated. If this does not loosen the pin, a thin fissure burr is introduced 
and the pin cut through. 

Describe the Logan crown and give the method of setting it 
with guttapercha. 

It is an all porcelain manufactured crown with a tapered pin of plati- 
num, baked into the body of the porcelain and protruding from the base. 
The base is concave and the pin on cross section is I-shape. 

The edges of the porcelain are ground to accurate adaptation with 
the end of the root, and the canal enlarged to receive the pin. The canal 
is dried and packed with guttapercha. Guttapercha is packed around 
the pin, filling the concave base, the crown and pin heated till guttapercha 
is quite soft, and the crown forced to place on the root. Cold water is now 
applied to the crown to harden the guttapercha, and the excess gutta- 
percha, which has been squeezed out at the gingival joint, removed with 
a sharp lancet. 

Describe the method of constructing a banded Logan cuspid 
crown. 

A gold band, floor and pin are made, assembled on the root, invested 
and soldered. The porcelain crown is ground to fit the labial border, 
leaving a space at the palatal border of about a thirty-second of an inch. 
Thirty-six gauge gold is burnished to the ground base of the porcelain 
crown and pierced to admit the head of the pin. The crown is now 
assembled on the root, adjusted to occlusion, hard wax flowed in joint 
from the rear, and the whole removed from the mouth, invested, soldered, 
smoothed and polished. 

What are the advantages of a detached pin crown? 

The grinding of the base is facilitated and the danger of grinding the 
pin eliminated in fitting the crown. In case of breakage a new crown 
may be fitted and cemented on the old pin. 

Describe a Mason detachable porcelain faced crown. State 
the advantages of its use and where applicable. 

The porcelain facing has a triangular bar baked in the back parallel 
with its long axis. A stamped gold backing having a triangular slot is 
sold with the facing. The crown is constructed as a Richmond, using 
this backing. The facing is removed during soldering, and cemented 
in place afterward. The advantages are the ease of repair, a new facing 
being ground to fit and cemented into the slot of the old backing. They 
may be used in all gold backed crowns and as facings in bridge work. 



PORCELAIN FACED CROWNS 383 

Describe the Steel interchangeable facing. State its 
advantages. 

Same as preceding facing (Mason), except that bar and slot are round 
instead of triangular, and that bar is on backing and slot in facing. 

Describe the method of constructing a porcelain faced 
bicuspid crown. 

A gold cap crown is constructed to fit the root. The labial surface is 
cut out, leaving the gold in the form of a narrow band under the labial 
gum margin. A facing is now ground to fit the cut out portion of the 
crown, backed and fitted, burnishing the gold at the margins to oblit- 
erate cracks. A little asbestos fiber is placed over facing and the crown 
wrapped with soft iron wire. The joints are now painted with flux on the 
inside, small pieces of solder placed over them, and the crown held in the 
flame of a Bunsen burner until solder has flowed completely around the 
joint. The crown is now pickled and polished. 

Upon what conditions does successful soldering depend? 

Upon the adaptation of the parts to be joined; the elimination of 
oxids and foreign substances from the surfaces on which the solder is to 
flow; proper distribution of flux and heat. 

What effect on the shade of teeth has (a) platinum, (b) gold 
backing. 

Platinum produces a bluish tint and gold a yellowish tint. 

In soldering a small piece of gold to a larger piece, on which 
should the solder be placed? Why? 

On the larger. The smaller piece will heat in advance of the larger, 
facilitating the direction of the solder from the cooler to the hotter surface. 

State the precautions that should be taken in backing a 
porcelain facing to prevent checking during soldering. 

Too great pressure should be avoided in bending pins. Absolute 
contact of backing and porcelain is essential to prevent borax from coming 
in contact with the porcelain. 

State the cause of pits in soldering. 

Insufficient flux or impure flux. Oxidization caused by continued 
insufficient heat. 

What causes porcelain facings to check and crack in soldering? 

Borax coming in contact with porcelain; too rapid heating or sudden 
cooling; previous strain on pins; and insufficient space for expansion. 

Mention the carat and gauge of plate most desirable for 
crowns. 

22 carat plate, 29 or 30 gauge. 

Describe the method of preparing and attaching a porcelain 
tip (lower third) to a central incisor with a vital pulp. 

The incisal surface is ground flat. With a fissure burr, a groove is cut 



384 PROSTHETIC DENTISTRY 

in the dentin, care being exercised not to encroach on the pulp. At 
each end of this groove, near the junction of dentin and enamel, a pit is 
drilled a sixteenth of an inch in depth. Platinum foil is now burnished 
to the flat end of tooth and well into the groove. A platinum pin is 
pushed through the platinum matrix to the bottom of each pit. Double 
headed pins are used. They should extend out far enough to be thor- 
oughly imbedded in the porcelain tip. The matrix with pins is carefully 
removed, and porcelain body built up to restore contour and baked. The 
enamel is now added and fused to a glaze. The platinum is stripped off, 
the tooth dried, and the tip set with quick setting cement. 

Describe a method of making and attaching a swaged shell 
corner for a central incisor, the cavity of which involves both 
labial and lingual walls and the masticating surface. 

The cavity is excavated, margin squared up and smoothed. A small 
piece of modeling compound is softened and pressed into cavity, chilled 
and carved to restore the shape and contour of the tooth. The com- 
pound is now removed from cavity and pressed into "moldine," and a 
fusible metal die secured. A piece of 30 gauge pure gold is swaged over 
this die and trimmed to the line of the cavity margin. Two or three 
pins are soldered on the concave surface to extend into the cavity, using 
enough solder to thoroughly reinforce the cap. The cavity and cap are 
now filled with soft cement and the cap pressed to place, burnishing the 
margins of the gold to absolute contact with the enamel. 

Give details of constructing a gold cap for a cuspid. 

The Sharpe system is valuable for a cuspid. The wire measure- 
ment of the root is obtained and a rubber form selected to meet the re- 
quirements of root size, length and contour. The form is mounted on the 
rubber base, and the metal flask placed in position over it. Fusible metal 
is poured into the flask and, when cool, the rubber form is removed, the 
metal removed from the flask and split in half with a cold chisel. A gold 
cylinder 22 carat, 29 gauge, and of the proper size, is annealed, placed 
in one-half the metal mould, the other half adjusted and the whole replaced 
in the flask. Soft wood sticks are now inserted into the open end of the gold 
cylinder, and with a few sharp strokes of a hammer the gold is adapted 
to the sides of the mould. The mould is now opened, the gold removed 
and annealed, returned to its position in mould, and filled with soft 
rubber. A small round end steel instrument is imbedded in the rubber, 
a few hammer blows bringing the gold into absolute contact at all points. 
The cap is now removed and fitted to the root, festooning the gum 
margin as indicated. 

Describe fully the method of preparing a molar tooth for a 
gold crown. 

With carborundum stones the occlusal surface is ground flat to 
allow for the thickness of the occlusal surface of the finished crown. 
The sides are made parallel with carborundum disks. When completed, 
the greatest circumference of the crown of the tooth should be just under 
the gum line. 



SHELL CROWNS 385 

Describe the operation of restoring a badly decayed molar 
crown by the use of a shell crown. Give the technic. 

All decayed tissue is removed with rose head burrs and the canals 
treated and filled. The pulp chamber is given a retentive form and all 
exposed surfaces bathed with a 25 per cent, solution of silver nitrate. 
Amalgam is now mixed and packed in pulp chamber and cavity, building 
it up with square walls to within one-sixteenth of an inch of the occlud- 
ing tooth. A wire measurement is now taken, a band cut and soldered, 
and the crown made and finished in the usual way. 

Describe a method of making a molar crown with a gold 
band, the cusps and grinding surface being cast thereon. 

The tooth is prepared and the band fitted and contoured. The 
top of the band should clear occlusion by a sixteenth of an inch. A bite 
and impression are taken, the band being removed and placed in its 
position in the impression, and the models run and articulated. The 
interior of the band is now filled to within a few lines of the edge with 
inlay investment, which is trimmed flat. Hard inlay wax is softened and 
pressed on top of the investment compound, covering the edges of the 
gold at all points. The grinding surfaces of the occluding teeth in the 
models are oiled and the articulator closed. This gives the impression 
of the occluding cusps in the inlay wax, which is now carved to represent 
a natural tooth. The band with wax in position is carefully removed 
from the model, a piece of sprue wire warmed and affixed to the wax, 
and the whole invested in a casting ring. When investment hardens, the 
sprue wire is withdrawn, the case is placed on the stove and heated 
slowly to dispel the wax. When all the wax has volatilized, the case is 
heated to redness throughout, a nugget of 22 carat gold placed in the 
crucible-formed top of the investment, the ring placed in position on 
casting machine, and the gold heated to a white heat and cast. When 
cool, the crown is removed from investment, the excess gold nipped off, 
and the surface finished with sand paper disks and polished with pumice, 
followed by rouge. 

Describe fully a method of constructing a gold cap or shell 
crown for a molar tooth, the cusps of which occlude accurately 
with the antagonizing tooth. 

The tooth being properly prepared, the circumference of the root is 
obtained in the following manner: A loop of fine brass wire is adjusted 
in a dentimeter and placed around the tooth under the gum. The 
wire is now twisted until it fits tight; when it is removed, cut in the center, 
and the ends straightened. This is laid on a strip of 22 carat, 29 gauge 
gold plate, and the length marked with a sharp instrument. A strip 
is cut the length of the wire guide and wide enough to extend from a 
point slightly under the gum margin to within a sixteenth of an inch of 
the occluding tooth. The two ends of the strip are bent around to join, 
and soldered with 20 carat solder. The band so formed is now fitted 
to the root extending slightly under the gum, so festooned that it will 
extend under the same distance at all points, and contoured. A small 
piece of modeling compound is now softened and placed in the open end 
of the band and the patient requested to bite. The compound is chilled 
25 



386 PROSTHETIC DENTISTRY 

and the band with compound in place removed. With the impressions 
of the occluding tooth as a guide, the compound is carved with a sharp 
knife to represent natural cusps, and returned to the mouth to verify the 
occlusion. It is now removed, inverted and pressed into moldin, 
producing an impression of the carved cusps and end of band. Fusible 
metal is poured into mould, and on the resulting die a piece of pure 
gold 36 gauge is swaged, trimmed and fitted to band from which modeling 
compound has been removed. Binding wire is wrapped around band 
and cusps, and borax placed inside and fused. Small pieces of solder are 
now placed in the crown, and flowed, uniting the band and cusps and 
reinforcing the cusps at one time. The crown is now pickled in sulfuric 
acid, smoothed and polished. 

State the remedy in cases of severe pain in the surrounding 
parts after a crown is mounted. 

The gum should be painted with aconite and iodin, equal parts. 
Small cotton wads, saturated in camphophenique may be kept on the 
gums for an hour, when as a rule the pain will have subsided. 

How would you repair a gold cap with a hole in it? 

If on the tooth, a cavity should be drilled in the underlying cement 
and a gold filling inserted, turning the edges of hole in and burnishing 
the filling over the margins. If not on the tooth, a piece of sponge gold 
is rolled up and inserted in the opening, and flattened on the outside. 
Borax is then placed in the crown with some pieces of solder, and the 
solder flowed over the gold. 

How would you remove a gold crown from a diseased 
molar tooth? 

Split the band on the palatal surface from edge to occlusal angle 
with crown slitters, fissure burr or sharp chisel. Spread flaps back and 
work a strong flat instrument between tooth and gold on the occlusal 
surface. A rotary movement of instrument will dislodge the crown, when 
it may be removed with the fingers. 

Give a method of taking an impression of a root for a gold 
crown. 

A ligature, wrapped with absorbent cotton, tied around end of root 
for a day will seal the gum away and permit of an accurate impression 
in dentallac being taken. 

State how a badly decayed root may be reinforced or strength- 
ened sufficiently to carry a dowel or pin crown. 

The decay is burred out, the canal enlarged, and undercut with a 
wheel burr. The walls of cavity are slightly grooved with a thin fissure 
burr. The canal and cavity are now packed with amalgam and a smooth 
steel pin forced into the canal. The amalgam is built up to restore the 
shape of the root, smoothed, and the pin gently withdrawn. The root may 
be further strengthened by encircling it with a gold band under the 
gum. 



BRIDGE WORK 387 

Mention the hygienic points to be considered in the applica- 
tion of bridge work. 

The perfect adaptation of abutments, absence of deep grooves, 
fissures or pits. The adaptation of the facings or dummies to the gum 
should permit of easy and perfect cleansing. 

In bridge work should the teeth fit the gum perfectly or 
should a space be left between the gum and the bridge? Explain. 

The teeth should just clear the gum to facilitate cleansing — not enough, 
however, to form a lodging place for food particles. 

How would you construct a bridge to supply the inferior 
first bicuspid and first and second molars, the remaining teeth 
being in place and sound? 

The second bicuspid and third molar should be squared up, and the 
occlusal surfaces made flat and ground to clear occlusion by one- 
thirty-second of an inch. Gold caps are constructed and fitted, and impres- 
sion and bite are taken. The two molar and first bicuspid facings are 
ground to fit, backed and mounted. Cusps are swaged and mounted, 
and the whole invested, soldered and finished in the usual way. 

Describe briefly the construction of a saddle appliance, 
supplying a bicuspid and molar without mutilation of the 
adjoining teeth. 

An impression and bite are taken and plaster models run and mounted 
on an articulator. Gold clasps are fitted to the second molar and first 
bicuspids, which are in place. Gold tongues are soldered to the clasps and 
the clasps placed in position on the model, the tongues extending into 
the space to be bridged. A roll of wax is softened and placed between the 
clasped teeth, and pressed down to conform to the ridge, which should 
have been covered with No. 60 tin foil. Vulcanite teeth of the proper 
size and shape are warmed and pressed into the wax and proper occlusion 
established. The wax is now smooth, the case invested, packed, vul- 
canized and finished. When finished, the tongues of the clasp should be 
imbedded in the vulcanite. This construction provides a strong firm 
bridge without mutilation of any teeth. 

Describe a method of using pinless bicuspids and molars as 
dummies for bridge work without casting directly on the 
porcelain. 

Steel's pinless facings may be used and set up as usual, the wax 
carved, and the facing removed, leaving the backing in the wax. The 
wax is invested and the cast made on to the backing. The cast dummies 
are assembled on the model, invested, soldered and polished, the facings 
being cemented to place the last thing before setting the bridge. If diatoric 
rubber teeth are used, the undercuts are obliterated and the tooth ground 
with a small stone, so that, by oiling the surface, they may be removed 
from the carved wax before investing. The cast dummy is made as de- 
scribed above, and the diatoric tooth cemented in place. 



388 PROSTHETIC DENTISTRY 

State the conditions necessary for successful soldering 
operation. 

Close adaptation and clean surfaces to be united; uniform and suffi- 
cient investment; ample heat properly manipulated. 

State the temperature that can be secured by use of the 
oxyhydrogen flame. 

Platinum — fusing point 3500 F. — may be melted with the oxyhy- 
drogen flame. 

Describe the blow pipe invented by Dr. J. Rollo Knapp, and 
state some of its uses. 

The blow pipe is used in connection with nitrous oxid gas. The gas 
cylinder is set upright in an iron base, and connected with the end of the 
blow pipe, a valve regulating the flow of gas. Beyond the valve is 
a mixing chamber from which runs a rubber hose to be connected with 
an illuminating gas jet. Just beyond the chamber is a wire gauge 
screen to prevent a flare back of the flame. The end of the pipe is branched 
to form two tubes, affording two size flames. The blow pipe produces an 
intensely hot flame. It is valuable in soldering where the flame should be 
intense at one point without unduly heating the surrounding area. Small 
pieces of platinum may be fused as with a true oxyhydrogen pipe. 

Describe a method of making an * 'interlocking occlusal 
rest" in a molar for one end of a bridge. Of what metal should 
the bar be made? 

The rest may be made by the casting process, the cavity being pre- 
pared as for an ordinary occluso-approximal gold inlay. The inlay is 
sast, placed in position in the cavity, and a deep dovetail groove cut in 
the occlusal surface, being continued out to the approximal surface. 
The sides of the groove are made parallel and the inlay removed. Iri- 
dio-platinum square wire is now filed to fit the groove in the inlay, form- 
ing a tight dovetail and a smooth occlusal surface. The inlay is set and 
the bar and other abutment placed in position before taking impression. 

What is the object of an investment? 

To retain in proper relationship the parts to be united and to protect 
the porcelain from the direct contact of the flame. 

What is the best investment for crown and bridge work? 

A combination of sand and plaster to which asbestos fiber has been 
added. 

What are the uses of silex in dentistry? 

It is mixed with plaster to form investment for cast work; to prevent 
porcelain fusing to the fire clay slab in porcelain work; to produce a 
smooth surface on plaster or vulcanite work; as one of the ingredients of 
porcelain teeth. 

What are the essential qualities of an investment material 
to be used in gold casting process? 

It should be ground very fine to produce a smooth surface. It should 



BRIDGE WORK 389 

take an accurate impression, be reasonably quick setting, strong enough 
to resist the force of the molten gold without fracture, and should 
neither contract nor expand in setting and only slightly expand on 
heating. 

Describe a method of constructing a cast gold bridge, using 
porcelain teeth on or between abutments. 

Using for example a bridge for the six anterior teeth, the cuspids 
used for abutments: The cuspid roots are prepared and fitted with a 
collar or cap and pin, as for a Richmond crown, and the bite and impres- 
sion taken with these in position. Models are run and articulated. 
Cross pin facings of appropriate shade and form are selected. The teeth 
are ground to fit the labial edge of the abutment caps and the dummies 
to the plaster gum, which has been slightly scraped. They are set up in pink 
wax and the wax carved to the form desired for the finished bridge. 
The facings are now carefully removed, and then pins of graphite inserted 
in the holes left by the pins. The wax with abutment cap and pins is 
carefully removed from the model, two converging sprues imbedded in 
the lingual surface and the whole invested in the casting ring. When 
dry, it is slowly heated to dispel wax, and 22 carat gold cast by the pres 
sure method. When cool, the investment is removed, the gold washed 
and boiled in sulfuric acid. The graphite is drilled from the pin holes 
and the facings set in their respective places by means of cement. The 
bridge after polishing is ready for the mouth. 

Describe a method of making the necessary parts of an 
upper cuspid porcelain faced crown with a split post to be used 
as one end of a removable bridge. 

The root is prepared as for an ordinary Richmond crown. The 
end of the root is banded and a floor soldered to the band. The root 
canal is enlarged to receive a platinum tube and a hole cut in the floor 
the diameter of the tube. The tube and cap are placed in position, touched 
with hard wax, withdrawn and soldered, and a small piece of gold plate 
is soldered to the free end of the tube. The cap with tube may now be ce- 
mented on the root. The rest of the crown is made as a Richmond, adapt- 
ing it to the gold band already fitted to the root and fitting the pins in the 
platinum tube. The pin is made to bind in the tube by constructing it of 
two bars of half round, iridio-platinum, faced together. One end of 
this double pin is of course imbedded in the gold solder of the crown, the 
free end opened enough to bind against the sides of the tube. 

Describe the construction of a bridge to replace the inferior 
central incisors, the remaining teeth being sound and in place. 

The lateral teeth are devitalized, a round cavity cut in the lingual 
surface including the pulp chamber and extended mesially to the mesial 
angle. Gold inlays with platinum pins running into the pulp canals 
are constructed for each cavity, the pins extending through the inlay 
and bent mesially to extend across the space of the missing centrals. 
A plaster impression is now taken with inlays and pins in place. When 
the impression is removed, the pins and inlays should be in impression. 
A model of sand and plaster is formed from this impression. Two 



390 PROSTHETIC DENTISTRY 

central facings are selected, ground to the gum, backed and mounted 
with hard wax to the bent pins. More sand and plaster is added to form 
an investment, when the case is soldered, finished, and polished. 

Describe a method of constructing a gold bridge to replace 
lost teeth between the cuspid and second molar, both named 
teeth being in place and sound. 

A gold cap is constructed for the molar and a Richmond crown for 
the cuspid. When these crowns have been adjusted, the bite is taken 
in wax, followed by a plaster impression. If the crowns do not come 
away with the impression, they should be removed and placed in their 
respective places in the impression and the model poured. The bite is 
now placed on the model, the articulating model poured and the two 
mounted on articulator. Appropriate facings are ground to fit the gum and 
to clear occluding teeth by a sixteenth of an inch. These are backed and 
mounted in wax on the model. From a die plate appropriate cusps are se- 
lected for each facing, and pure gold, 30 gauge, swaged into them. Solder 
is flowed in the cusps, which are then filed to fit the edges of their respective 
facings and mounted in position in the wax, occluding properly with the 
teeth on the antagonizing model. The case is now invested, the wax 
removed, heated slowly to redness, and 20 carat solder flowed from the 
molar crown to the Richmond, uniting all backings and cusps. Suffi- 
cient solder should be used to form a strong bridge, the under surface 
of which would present a nearly flat, sloping plane from the lingual 
edge of the backings. The bridge is now boiled in acid, smoothed with 
sand paper disks and polished. 

If a bridge, extending from the canine to the third molar, 
breaks in the middle, what is the method of repairing it? 

The two halves should be removed, cleaned in sulfuric acid, and 
placed back in position in the mouth with the broken ends in correct 
relation. An impression is now taken, using a very soft mix of sand and 
plaster. The bridge should be removed in the impression. With a 
knife edge stone a groove is cut in the solder on the under side, at right 
angles to and crossing the break. A bar of iridio-platinum is laid in this 
groove and the break and groove filled with solder. 

Give a method of making and attaching a removable bridge. 

The sides of the abutment teeth are ground parallel, and caps, the 
sides of which are parallel or slightly cone shaped and tops flat, 
are constructed. Contoured telescoping caps are constructed for each 
abutment cap. Impression and bite are taken with caps in position and 
the resulting models articulated. Dummies are constructed to replace 
the missing teeth, mounted, the case invested and soldered in exactly the 
same manner as a fixed bridge. The under caps are cemented on the 
abutments and the close fit of the telescope crowns hold the bridge firmly 
in position. 

Describe a method of constructing a bridge extending from 
a lower first bicuspid to a third molar, both teeth inclining 
toward each other. 

An occlusal cavity may be cut in the molar extending to, and a 



BRIDGE WORK 3QI 

short distance down the mesial surface for the reception of a gold inlay. 
It should be prepared without undercuts, with a dovetail form in the 
occlusal portion and so shaped generally that the wax w'll draw only in 
a direction parallel to the slant of the first bicuspid. The bicuspid 
should be squared up and a gold cap made and fitted. A gold inlay 
is cast for the molar cavity with a platinum lug imbedded and extend- 
ing one-quarter inch toward the bicuspid. A bite and impression 
with parts in position are taken and models run and articulated. Facings 
are ground, backed and fitted. Cusps swaged, reinforced, and adjusted. 
The whole is now invested and soldered with 20 carat solder, finished 
and polished. This gives a bridge the abutments of which go to place 
in parallel lines regardless of the slant of the abutment teeth. 

State the method of making the grinding surface of a bridge 
with one continuous piece of gold. 

A bite and plaster impression are taken with the abutments in place. 
If abutments do not remain in impression they are removed and placed 
in their proper positions. The models are now run and articulated. 
Facings are ground to fit gum and clear occluding teeth by a sixteenth 
of an inch, backed and mounted in pink wax, which has been laid along 
ridge from abutment to abutment. The occluding plaster teeth are 
oiled, the wax warmed and the articulator closed, giving an impression 
of the occluding teeth. The wax is now carved to reproduce cusps and 
sulci, removed from articulator and gently pressed into soft " mol dine " 
and a die of fusible metal run; 30 gauge gold is now swaged over the 
die, trimmed, and the cusps reinforced with solder. It is now placed 
in position between abutments, the facings waxed in position and the 
whole invested and soldered in the usual way. 

How should the loss of a superior lateral incisor be supplied? 

Of the numerous ways, the following seems to be one of the best. 
From a plaster impression, which should include the central and 
cuspid teeth, a metal die is made. A strip of 30 gauge 22 carat gold, 
long enough to cover the palatal surfaces of both central and cuspid, is 
swaged on the die. This plate is held in position on the teeth and two 
holes drilled through the gold and into the dentin of each tooth and under- 
cut. A flat-headed platinum pin is placed in each hole and attached to 
gold with hard wax. The gold plate is removed from the mouth, 
invested, solder flowed over the pins and returned to the mouth, where 
the margins are beveled and burnished to a tight joint with the enamel. 
Another impression is now taken with the plate in position. The plate is 
removed, placed in position in impression and a model run. A facing is 
now selected which will almost fill the space, ground, beveled, and waxed 
in position against the plate. The whole is invested, soldered, finished 
and polished. Set with cement. 

How would you secure an anchoring bar to a vital tooth? 

By means of a gold inlay with an undercut slot for the reception of the 
bar, filling the slot around the bar with cohesive gold. In the posterior 
teeth amalgam packed around bar is sufficient. 



39 2 PROSTHETIC DENTISTRY 

State a method of preparing and filling a cavity in a porcelain 
tooth. 

The cavity is drilled its full depth with a diamond drill and enlarged 
with a carborundum point. The tooth is imbedded in modeling compound 
to facilitate handling. The compound is held on a hard resisting base 
and the filling inserted by hand pressure, using crystal gold. 

Describe Brown's porcelain bridge, stating advantages and 
disadvantages. 

It consists of a bar of iridio-platinum bent to enter the root canals 
of abutments and forming the framework or support of an all-porcelain 
bridge. The facings are fused to the bar and body, and enamel carved 
and baked to restore contour and occlusion. When well made it is very 
pleasing in appearance and cleanly, but frequently requires great destruc- 
tion of healthy tooth structure for its adaptation. The risk of fracture 
and the difficulty of repair are also disadvantages. 

Why is silver not used in crown and bridge work? 

Because it turns black and unsightly and finally corrodes in the fluids 
of the mouth. 

State the relative merits of guttapercha and cement as a 
retentive medium for crowns and bridges. 

Cement is firmer, more adhesive, is better adapted to undercuts and 
depressions, and gives better support to overlying metal. Guttapercha is 
more resisting to the action of the oral fluids and facilitates removal at any 
time. It also acts as a bursa or cushion, relieving the full force of shock 
to the underlying tooth. 

Describe the method of using guttapercha for setting crowns 
and bridges. 

The guttapercha is placed on a flat iron bar and the bar heated. It 
is left on the bar while being used to keep it softened. The crown or 
bridge abutment to be set is warmed, half rilled with the soft guttapercha 
and pressed firmly on the moist tooth or root, the excess material being 
squeezed out. The proper adjustment is secured and the piece removed. 
The excess is trimmed away and the piece allowed to cool. A thin coat- 
ing of very soft guttapercha is now added and the crown or abut- 
ment forced firmly and quickly to place. The root or tooth should be 
thoroughly dried before setting. 

Describe the method and material you would use to secure 
a perfect impression of the inferior maxilla when fractured. 

The fractured end should be brought into correct relation and the jaw 
held firmly in this position by an assistant. A deep tray is oiled and 
the impression taken with soft plaster. The tray is removed, the 
impression split, removed in sections, and assembled in the tray. 

Describe the method of constructing an interdental splint. 

Models are secured and articulated. If the model of the lower jaw 
reproduces the malocclusion due to the fracture it is sawed through at the 






OBTURATORS 393 

point corresponding to the fracture and reassembled to articulate normally. 
The jaws of the articulator are now set with the anterior teeth separated 
about one-half an inch. No. 60 tin foil is now carefully burnished over 
the occlusal surfaces and lower and upper thirds of the upper and lower 
teeth on the plaster models. A layer of rubber is warmed and moulded to 
the foil on both models. Rubber posts are rolled to unite the two layers 
of rubber at the canine and first molar on each side. The surface of the 
rubber is now smoothed with a hot burnisher. Plaster is mixed and 
run in from the back, filling the palatal and lingual spaces and uniting 
the two models. The models are now removed from the articulator, 
flasked with one pour of plaster, and the case vulcanized and polished. 

Give a method of obtaining an impression of a perforated 
hard palate. 

Impression plaster is mixed, adding a few grains of salt, and the per- 
foration filled flush with the roof of the mouth. The surface is coated 
with liquid soap and the impression of the palate taken. When hard, 
the impression is removed, and with pliers the hardened mass of plaster 
in the perforation is forced backward and downward, and removed, 
placed in position on the impression and waxed. 

Give the method of taking an impression of a cleft palate. 

A suitable tray is selected and lengthened by attaching a sheet of base 
plate guttapercha. The tray should be tried in and the guttapercha 
trimmed, heated and the edge turned up to form a cup. The soft palate 
is painted with a 2 per cent, solution of cocain. The tray is now filled 
with plaster of Paris, inserted and pressed to place. It is held stationary 
until the plaster will break clean and sharp, when it is removed. 



What is an obturator? 

It is an appliance constructed to fit and close a cleft in the hard palate, 
usually made of vulcanite. 

What is an artificial velum? 

It is a rubber appliance constructed to restore loss of, or supply the 
lack of tissue in the soft palate. 

Describe the way in which the surrounding muscles control 
an artificial velum. 

The velum is made in two sections: An upper and lower, joined 
along the median line. The remaining edges of the soft palate fit between 
the upper and lower plates of the velum and raise and lower it during 
the act of deglutition. 

Describe the method of constructing an obturator. 

From a plaster impression a model is obtained. The reproduction of 
the cleft in the model is filled with wax, and dies and counter-dies run. 
A gold plate is now constructed with clasps for the first molar teeth and 
an extension posteriorly to support the obturator. A loop of wire is 
soft soldered to upper side of the gold extension, and a mass of softened 



394 PROSTHETIC DENTISTRY 

beeswax moulded around the wire, approximating the shape of the fissure. 
The plate and wax are placed in the mouth and the patient requested to 
swallow several times. This action moulds the beeswax to the desired 
shape. The case is now removed and the wax trimmed flat top and bottom. 
Posteriorly the wax is trimmed to allow the soft palate to close under it. 
Plaster is now placed on the upper surface of the plate anterior to the 
wax, the plate pressed to position and an impression of the anterior end 
of cleft obtained. Tin foil patterns of the top and bottom of the wax 
mould, and a strip representing the circumference of the sides and ends, 
are cut, reproduced in unvulcanized rubber, and a hollow box formed by 
squeezing the edges of the rubber together. Before sealing entirely, the 
rubber box should be half filled with water. The case is now flasked, 
the wax removed and the rubber box substituted and vulcanized. The 
obturator is fastened to the plate by means of a platinum bar soldered to 
the plate and passing through the bulb, with a nut on the free end. Gutta- 
percha is heated and interposed between plate and bulb before screwing 
nut down tight. 






INDEX 



Abrasion of teeth, 326 

etiology and treatment, 326 
results after, 265 
Abscess, 207 

acute, definition, 287 
formation of, 207 

of antrum, diagnosis, symptoms and 
treatment, 296 
alveolar, abortive treatment, 241 

and pericementitis, differentiation, 267 

cause, 267 .„ 

causing inflammation of maxillary sinus, 

296 
external fistula with adhesions from, 

treatment, 304 
treatment, 333 

after infection has taken place, 304 
without fistula, treatment, when roots 
have been properly treated and filled, 

blind, chronic, of lower teeth, treatment, 
333 
definition, 333 
chronic, definition, 287 
definition, 287 

of deciduous tooth, treatment, 324 
of hard palate, etiology, symptoms, and 

treatment, 297 
of temporary teeth, dangers, 267 
pericemental, diagnosis and treatment of, 

332 
pointing, 207 
Absorption, 34, 168 
alimentary, 170 
by blood-vessels, 170 
by lungs, 1 70 
by lymphatics, 170 
by skin, 170 
channels, 169 
Accelerator urinae, 184 
Accessory sinuses of face, anatomy, 121 
Accidental immunity, 226 
Accommodation, 191 
Acetanilid, dose, 2s 1 
in neuralgia, 250 
Acetic acid, 70 

formula, 71 
Achromatin, 130 
Acid, 37 
acetic, 70 

formula, 71 
arsenious, 239 

to obtund sensitive dentin, 239 
benzoic 75 

butyric, fermentation, 69 
carbolic, 73, 248 
antidote for, 73 
as disinfectant, 263 
chemical antidotes, 249 
dental use, 248 

dose, for internal administration, 249 
in mouth conditions, 249 
injuries of mouth from, treatment, 304 
poisoning from, 249 

chemical treatment, 78 
treatment, 249 
properties, 249 
therapeutic uses, 238 
to obtund sensitivity of teeth, 327 
whence derived, 248 
carbonic, formula, 30 



Acid, chemical nomenclature, 38 
chromic, 246 

dental uses, 246 
citric, 75 

danger of using, in mouth, 247 
essent : al element, 39 
hydrochloric, 60, 154 

action on zinc, 97 

chemical formula, 30 

poisoning by, antidotes, 77 
hydrochloric, properties and uses, 245 
hydrocyanic, medicinal uses, 260 

poisoning by, antidote, 78 
hydrogen, 39 
lactic, 75 

fermentation, 69 

in dental caries, 81 
mineral, poisoning by, antidotes, 77 

used in dentistry, 245 
muriatic, 60 

chemical formula, 30 
name, 35 

nitric, 51 

chemical formula, 30 

formation of, equation showing, 33 

formula, 30, 41 

graphic formula, 29 

molecular weight, 41 

poisoning by, antidotes, 77 

properties and uses, 245 
nitrohydrochloric, 52 
oleic, glycerid of, 81 
organic, 70 

in vegetables and fruits, 75 
oxalic, 75 1 

formula, 70 

poisoning by, antidote, 76 
palmitic, glycerid of, 81 
phosphoric, 58 

dental uses, 30 

glacial, 58 

graphic formula, 29 
precautions in using, in mouth, 247 
protection of teeth from, 251 
salicylic, 68 
salt, 37 

stearic, glycerid of, 81 
sulfuric, 56 

action on zinc, 97 

chemical formula, 30 

dental uses, 30 

formula and molecular weight, 41 

graphic formula, 29 

in mouth conditions, 246 

in pyorrhea alveolaris, 245 

percentage of constituents, 44 

properties and uses, 245 

poisoning by, antidote, 77 

reaction of, on common salt, 3$ 
sulfurous, 56 

sulphuric. See Acid, sulfuric. 
tartaric, 74 
trichloracetic, 245 

dental uses, 30, 245 
uric, in body, 184 
used in medicine, three, 39 
Aconite, 244, 261 

action on blood-vessels, 257 
antidotes for, 244, 258 
decreasing blood-pressure, 259 
dental uses, 244 



395 



39^ 



INDEX 



Aconite, dose, 244, 258 

effect on heart, 259 

local action, 259 
medical property, 244 

physiologic action, 261 

reducing fever, 259 

remedy that antagonizes constitutional 
action, 259 
increases constitutional action, 259 

synergists of, 259 

tincture of, dose, 259 
toxic effects, 258 
Addison's disease, pathologic changes in, 217 
Adenoids, conditions of superior maxilla and 
teeth caused by, 314 

definition, 298 

microscopic appearance, 219 
Adenoma, 292 

histology, 214 
Adhesion, 18 

Adipose tissue, microscopic appearance, 134 
Adrenalin chlorid, action on blood-vessels, 257 
Aerobic, definition, 222 

facultative, and facultative anaerobic, 
differentiation, 222 
Afferent nerve- fibers, 185 
Affixes, chemical, 38 
Agglutination reactions in diseases other 

than typhoid fever, 229 
Air, 52 

carbon dioxid in, 53 

changes in, due to respiration, 152 

complemental, 153 

composition, # 1 53 

compressed, in dentistry, 246 

ground, effect on health, 271 

inspired, 153 

reserve, 153 

residual, 153 

tidal, 153 
Air-passages, effect of tobacco on, 284 
Albumin, 82 

boiling test, 82 

effect of zinc chlorid on, 83 

in urine, test, 82 

Millon's test, 82 

xanthoproteic test, 82 
Albuminoid degenerations, 201 
Albumose, 165 
Alcohol, 70 

absolute, 70 

action of chlorin on, 74 

as heart stimulant, dose, 257 

boiling-point, 21 

common, 70 

contaminations, 71 

denatured, 73 

effect, on gastric juice, 158 

ethyl, 70 
formula, 71 

excessive use, 166 

food value, 166 

freezing-point, 21 

grain, 70 

methyl, 71 

physiologic uses, 165 

to obtund sensitivity of teeth, 327 

wood, 71 
Alcoholometer, 22 
Alexins, 227 
Alimentary absorption, 170 

canal, secretions, 154 
subdivisions, 125 

essentials, 165 
Alkalies, 35, 242 

caustic, poisoning by, antidote, 77 

dental uses, 242 
Alkaline substance, 39 
Alkalinity of blood, 144 
Alkaloids, 75 

of opium, 250, 260 
Allotropism, 36 
Allotropy, 36 
Alloy, 40 

annealing, 91 



Alloy, effect of heat on, 91 
Alloying, 91 
gold, 93 

effect of tin on, 94 
for clasps and springs, 94 
Alteratives, 241, 245 

Altitude, high, contraindications to, 269 
Aluminum, 97 

annealing, method, 375 
atomic weight, 31 
dental uses, 375 

in construction of artificial dentures, 376 
oxid, common name, 43 
symbol and atomic weight, 88 
Alveolar abscess, abortive treatment, 241 
and pericementitis, differentiation, 267 
cause, 267 
causing inflammation of maxillary sinus, 

296 
external fistula with adhesions from, 

treatment, 304 
treatment, 333 

after infection has taken place, 304 
without fistula, treatment, when roots 
have been properly treated and filled, 
333 
margin, 118 

process, arsenical necrosis, etiology, symp- 
toms, and treatment, 297 
cause of absorption after extraction of 

teeth, 35s 
cysts, 215 
ossification, 140 
ridge, relation of artificial teeth to, 360 
Alveolo-dental membrane, 140 
Amalgam, 40, 87 

and cement for broken crowns, 347 

and gold filling, 349 

copper, 99 

filling, 99, 342, 346 

preparation and insertion, 354 
refuse, silver in, obtaining, 96 
washing, 99 
Amboceptors, definition, 226 

hemolytic, 232 
Ameloblasts, 137 
American gold coin, carat, 374 
Amitosis, 198 
Ammonia, 52, 65 
aromatic spirits, as heart stimulant, dose, 256 
by inhalation as heart stimulant, 258 
graphic formula, 29 
Ammonium bifiuorid in pyorrhea alveolaris, 
245 
chlorid, 65 

graphic formula, 29 
hydrate, formula, 43 
Amorphous substance, 23 
Ampere, 24 
Amphiarthrosis , 122 
Ampulla of Vater, 161 
Amputation of root of tooth, 334 
Amyelinic neuroma, 213 

Amyl nitrite by inhalation as heart stimulant, 
258 
dose, 256 

effect, on vascular system, 259 
for what used, 256 
how administered, 259 
method of administering, 256 
phyical properties, 259 
uses, 259 
Amylase, 81 
Amyloid degeneration, 201 

foods, 164, 165 
Amylopsin, 81, 159 

functions, 155 
Amylum, 80 
Anabolism, 78, 173 
Anaerobe, facultative, definition, 220 
obligate, definition, 220 
pathogenic, 221 
Anaerobic, definition, 222 

facultative, and facultative aerobic, dif- 
ferentiation, ,222 



INDEX 



397 



Anaerobic organism, 220 
Analgesics, 241 

Analysis, 90 

Analytic methods in chemistry, 40 
Anasarca, chronic parenchymatous nephritis 
giving rise to, 201 

definition, 201 
Anatomy, 100 

morbid, definition, 197 
Anchorage, Baker's system, 319 

Jackson's system, 319 
Anchoring bar, securing, to vital tooth, 391 
Anelectrotonus, 180 
Anemia, 203 

affections of secretions in, 230 

pernicious, and anemia, differentiation, 203 
Anesthesia, collapse in, 310 

contraindications, 309a 

for dental operations, 309a 

S;eneral, agents for, 309 
ocal, agents for, 309a 
of mucous membrane, 311 
of skin, 311 
mechanical asphyxia in, 311 
muscular system in, 309a 
preparation of patient, 3096 
remedies and instruments at hand, 3096 
stages, 310 
Anesthetics, 254 

contraindications, 309a 
for operations about mouth, 309a 
general, 254 
local, 254 

used in dentistry, 255 
Anesthetization method of removing tooth 

pulp, precautions, 238 
Angioma, 292 

Angle's appliance for retracting a cuspid, 319 
class 2 of malocclusions, relation of lower to 

upper arch in, 315 
facial line of harmony, 314 
fine of occlusion, 313 

method of noting variation from normal 
in arches, 314 
of retracting protruding lower jaw, 319 
of treating fractured maxilla or mandible, 
320 
Anhydrous substance, 39 
Animal body, tissues, 130 

foods, conversion of minerals into, 79 
heat, 20, 175 
life, 79 

lowest form, 130 
Anions, 30 
Ankle-clonus, 186 

Ankylosis, confirmed, surgical methods for 
re-establishment of joint function in, 294 
prevention, after injury to joint, 294 
varieties, 294 
Annealing alloys, 91 

aluminum, method, 375 
metals, 90 
Annulus ovalis, 100 
Anode, 25 
Anophles, 281 

Anospinal center, Budge's, in defecation, 157 
Antacids valuable for use in mouth, 248 
Antagonist and antidote, difference, 236 
Antibody, 232 

Antidote and antagonist, difference, 236 
chemical, 236 

and physiologic, differences in action, 68, 

252 
for carbolic acid 249 

for hydrargyri chloridum corrosivum, 253 
for sugar of lead, 62 
in poisoning by tartar emetic, 44 
for aconite, 244, 258 
for arsenic, 65, 66, 250, 258 
for bichlorid of mercury, 250 
for carbolic acid, 73 
for corrosive poisons, 252 
for creosote, 244 
for iodin, 250 
for morphin, 259 



Antidote, for opium, 250 

for phosphorus, 250 

for quinin, 244 

in carbolic acid poisoning, 78 

in copper sulfate poisoning, 76 

in hydrochloric acid poisoning, 77 

in hydrocyanic acid poisoning, 78 

in iodin poisoning, 77 

in morphin poisoning, 78 

in nitric acia poisoning, 77 

in opium poisoning, 78 

in oxalic acid poisoning, 76 

in phosphorus poisoning, 77 

in poisoning by caustic alkalies, 77 
by mineral acids, 77 

in strychnin poisoning, 78 

in sulfuric acid poisoning, 77 

mechanical, 236 

physiologic, 236 

and chemical, differences in action, 252 
to cocain, 250 
Antigen, 232 
Antimony, effect on heart, 259 

potassium tartrate, 75 

symbol of, 27, 88 

tests for, 67 
Antiphlogistic, definition, 248 
Antipyretics, 237 
Antipyrin, dose, in neuralgia, 250 
Antiseptic, coagulating, 244 

noncoagulating, 244 
Antiseptics, 55 

and disinfectants, differentiation, 262 

definition, 221, 222 
Antitoxins, 227, 284 

definition, 226, 227 

diphtheria, dose, 228 

factor and unit as applied to, 228 
how obtained, 228 

mode of preparation, 284 
Antrum, abscess, acute, diagnosis, symptoms, 
and treatment, 296 

maxillary, diseases of, 296 
tumors of. 296 

of Highmore. 122. See Maxillary antrum. 
Apex-beat of heart, 148 
Aphasia, 181 
Aphonia, 181 
Apnea, 153 
Apomorphin as emetic, dose, 256 

dose, 251 
Aponeuroses, anatomy, 112 
Appendix, auricular, 100 
Aqua ammonias, 52 

regia, 52 
Aqueous humor, 128 

solution containing three drugs, complete 
prescription for, 263 
definition, 264 
prescription containing, 264 
Arachnoid, anatomy, 106 

function, 190 
Arch, expanding, injury from too much force, 
316 
Norton-Talbot spring in, 316 
Archiblastoma, 211 
Argyrol, 61 

Arm, motor center for, 190 
Aromatic sulfuric acid, 57 
Arsenic, 65, 67 

antidote for, 65, 66, 250, 258 

dose, 258 

drugs combined with, for devitalizing tooth 
pulp, 239 

for devitalization of pulp, 33c 

indications for use, 239 

injurious effects on gums, treatment, 239 

Marsh's test for, 67 

oxid, 65 

physiologic action, 239 

poisoning, 66 

of gum tissue, symptoms, 330 
Reinsch's test, 66 

preparation used in dentistry, 239 

symbol of, 27 






398 



INDEX 



Arsenic, toxic effects, 258 

white, 65 
Arsenical necrosis of alveolar process, 297 
Arsenious acid, 239 

to obtund sensitive dentin, 239 

iodid, 65 

oxid, 65, 239 
Arsenobenzol in syphilis, 309 
Arterial blood, 144 

in liver, 160 
Arteries, anatomy, 134 

calcareous degeneration, 218 

carrying venous blood, 150 

coronary, 100 

degenerative changes of, 218 

functions, 150 

hypogastric, 195 

ligation, steps, 290 

pressure in, 149 

structure, 100, 150 
Artery, axillary, 101 

carotid, external, 101 

dental, inferior, 101 

facial, ligation of, 290 

hepatic, 160 

lingual, 1 01 
ligation, 290 

maxillary, internal, 101 

subclavian, 101 
Arthritis deformans, changes in cartilage in, 

210 
Articulate speech, center of, 181 
Articulation and occlusion, differentiation, 
313 

faulty, of artificial teeth, 360 

maxillary, noisy movements, cause and 
treatment, 294 

of teeth in protruding mandible, 318 
Articulator. Bonwill, 361 
Artificial dentures, aluminum in construction, 

375 

base hygienically best, 376 

causes of failure, 358 

construction, on celluloid base, 367 
on gold base, 372 
on vulcanite base. 363 

Griswold retainer for, 366 

impression for, conditions considered, 356 

lower, construction by cheoplastic proc- 
ess, 368 

materials as base for, 361 

methods of retaining, 366 
ice, advantages, 277 
teeth, arrangement on model, 360 

counter-sunk pin, advantages, 369 

diatoric, advantageously used, 369 

diseases of mouth contraindicating, 355 

faulty articulation, 360 

for edentulous mouth, 359 

general principles in arranging, 360 

ingredients used in manufacture, 368 

long bite, 368 

lower, 355 

correct bite, 359 

relation in length to lower lip, 359 

normal occlusion, 360 

pinless, advantageously used, 369 

plain, and gum sections, relative merits, 
368 

plaster-of -Paris impression for, 357, 358 

platinum as coloring agent for, 368 
pins for, 369 

preparation of mouth for, 35s 

relation, to alveolar ridge, 360 

short bite, 368 

size, form, and color for bilious, sanguin- 
eus, nervous, and lymphatic tempera- 
ment, 3 59 

upper, correct bite, 359 

relation in length, to upper lip, 359 

wax impression for, 357, 358 
velum, definition, 393 

manner muscles control, 393 
Artisans, diseases liable, 277 
Arytenoid cartilage, 123 



Asbestos, properties, 92 
Asepsis, definition, 221 
Asphyxia, 153 

definition, 311 

mechanical, in anesthesia, 311 

resuscitation, in, 256 

treatment, 311 
Assay, 90 
Assimilation, 168 
Astigmatism, 192 

regular, 192 
Astringents, 245 

mineral, 245 

vegetable, 245 
Atheroma, pathology, 218 
Atmosphere, 269 

constituents of, 52 
Atom, 32 
Atomic theory, 31 

weight, 28, 31 
Atomicity, 28 
Atrophic nasopharyngitis, changes in tissue in, 

219 
Atrophy, 200 

brown, 200 

neuropathic, 200 

physiologic, 200 

pressure, 200 

senile, 200 

simple, 200 

varieties, 200 
Atropin, 75, 76, 242 

dose, 242 

effect, on salivary glands, 155 

poisoning and strychnin poisoning, differ- 
entiation, 252 

sulfate, 238 

as heart stimulant, dose, 256 
dose, 238 

with morphin hypodermically, 258 
Attraction, 18 

chemism, 32 
Auditory canal, functions, 193 

meatus, external, 121 

ossicles, 193 
Auricles of heart, 100 
Auricular appendix, 100 
Autogenous soldering, 371 
Avogardo, law of, 32 
Axillary artery, 101 
Axis-cylinder, 136 
Azote, 50 

Babitt metal, composition, 374 
Bacillus, definition, 220 

smegma, and tubercle bacillus, differentia- 
tion, 230 

where found, 230 
tubercle. See Tubercle bacillus. 
Bacteria associated with inflammation and 

suppuration, 229 
basic forms, 220 
classification, 220 

conditions favorable for growth, 220 
definition, 220, 221 
development, in mouth, 223 
different ways of entering body, 220 
essentials to life, 223 
functions, 223 
in intestines, 162 

in milk and tubercle bacillus, differentia- 
tion, 230 
methods for recognition and cultivation, 

220 
modes of propagation, 223 
pathogenic, action of leucocytes on, 227 

definition, 221 

or non-pathogenic, method of determin- 
ing, 224 

protective agencies by which body 
guards itself against, 226 
per cubic centimeter in water, method of 

finding, 22s 
products, 223 
pyogenic, 221 






IN 1>1 X 



399 



Bacteria, related etiologically to develop- 
ment of surgical septicemia, 229 

requirements essential for pathogenicity, 

saprophytic, definition, 221 
staining, reasons, 223 
Bactericidal power of blood serum, 227 
Bacteriology, 220 
Bacterioproteins, definition, 226 
Baker's system of anchorage, 319 
Bandage, Barton's, 307 

Gibson's, 307 
Bar, anchoring, securing, to vital tooth, 391 
Barium, flame test, 41 
Barometer, 21 
Bartholin's duct, 103 
Barton's bandage, 307 
Base metals, 87 
Bases, 37 
Bathing, 178 
Baths, 277 
public, 276 

Turkish, contraindications, 277 
Beefsteak, digestion, 167 
Belladonna, 238 

habitat, 251 
Bellini's tubes, 182 
Bell's law, 188 
Benzoic acid, 75 

Bichlorid of mercury, antidote for, 250 
as disinfectant, 263 
dose, 245, 250 
objections to, for sterilization of dental 

instruments, 322 
1 to 2000 solution, prescription for, 264 
poisoning by, symptoms and treatment, 
253 
Bicuspids, approximal cavities in, prepara- 
tion and filling, 339 
crown, porcelain faced, construction, 379, 

383 
extraction, 353 

first superior, pulp chamber of, 142 
jacket crown with porcelain facing, 378 
irregularity, 315 

lower, Case's appliance for raising occlusion, 
3i7 
first and second, distinction, 141 
method of elongating, 317 
Bile, 154, 161 
capillaries, 161 
salts, 161 
Bile-ducts, 161 
common, 161 
Bilious temperament, size, form, and color of 

artificial teeth for, 359 
Bilirubin, function, 174 
Bivalent, 28 
Black rubber plate, 363 

facing with pink, method, 363 
vulcanite, coloring pigment in, 362 
Blastoderm, 130 
Bleaching, 49 
teeth, 334 

calcium hypochlorite for, 240 
sodium dioxid for, 240 
vulcanite, 363 
Blind abscess, chronic, of lower teeth, treat- 
ment, 333 
definition, 333 
Blindness, color, 192 
Blood, alkalinity, 144 
amount in body, 144 
arterial, 144 

in liver, 160 
changes during respiration, 152 

in liver, 160 
circulation, 147 
coagulation, 144, 145 
coloring matter, 85 
composition, 85, 145 
condition, in gout, 218 

in rheumatism, 203 
constituents, 103 
effete matter, elimination, 172 



Blood, cxtravasated, changes in, 203 
function, 145 

pathology, 203 

physiology, 144 
platelets, 103 
portal, in liver, 160 
reaction, 145, 146, [59 
renewal, after hemorrhage, 144 
specific gravity, 145 
venous, 144 

arteries carrying, 150 

in liver, 161 
Blood-corpuscles, red, 103, 145, 146 

movements, in capillaries, 151 
white, 103, 146 

definition, 227 

movements, in capillaries, 151 
Blood-current, venous, maintenance, 150 
Blood-plasma, pathologic blood-changes i», 

Blood-poisoning. See Septicemia. 
Blood-pressure, 149 

aconite decreasing, 259 

digitalis and strophanthus increasing, 
258 

drugs that increase, 258 

effect of chloroform on, 255 
of ether on, 255 

medicines decreasing, 259 

nitroglycerin decreasing, 259 
Blood-serum, bactericidal power, 227 
Blood-vessels, absorption by, 170 

action of aconite on, 257 
of adrenalin chlorid on, 257 
of digitalis on, 258 

functions, 150 

local action of aconite on, 261 
Blow-pipe, Knapp's, 388 
Blue vitriol, 56 

chemical name and formula, 27, 30 
Blushing, physiology, 148 
Body, composition, 78 

fusing, high, 350 
low, 350 
Boiling test for albumin, 82 

water, temperature, 273 
Boiling-point, 21 
Bone cells, 116 

conversion of osteoblasts into, 135 

chemical components, 85 

chemistry, 85 

compact, 115 

degenerative inflammation, 210 

diseases, 294 

fistula, 209 

formation, methods, 116 

hypertrophic inflammation, 210 

inflammation, changes characterizing, 210 

inflammatory diseases, 287 

inorganic salts, 85 

long, fracture, reparative process after, 210 

necrosis, 209, 252 
causes, 252 

etiology and pathologic anatomy, 209 
treatment, 252 

of cranium, 116 

of face, 117 

pathology, 209 

spongy, 116 

suppurative inflammation, 210 

syphilitic lesions, 308 
Bonwill articulator, 361 

crown, 380 
Borax as flux in soldering and melting metals, 
37o 

chemical name and formula, 30 
Boron, symbol of, 27 
Bowman's capsule, 129, 182 
Brain during sleep, 184 

fissures of, anatomy, 106 

gray matter, physiology, 189 

hemispheres, anatomy, 106 

lobes, anatomy, 106 

membranes of, functions, 190 

postmortem examination, 197 



400 



INDEX 



Brain, ventricles, anatomy, 107 
Branchial arches, 127 
Brass, composition, 91 

wire, 98 
Bread-and-milk meal, gastric digestion, 166 
Breathing, bronchial, 152 

vesicular, 152 
Bridge between canine and third molar, 
fracture in middle, repair, 390 
lower first bicuspid and third molar, 
method of construction, 390 
Brown's porcelain, 392 1 
cement as retentive medium, 392 
gold, cast, construction of, using porcelain 
teeth on or between abutments, 389 
to replace teeth between cuspid and 
second molar, 390 
grinding surface, method of making with 

one continuous piece of gold, 391 
guttapercha as retentive medium, 392 
indications and contraindications, 322 
porcelain, Brown's, 392 

removable, method of making and attach- 
ing, 390 
to replace inferior^ central incisors, 389 
work, hygienic points, 387 
fit of teeth in, 387 
investment for, 388 
method of using pinless bicuspids and 

molars as dummies for, 387 
to supply inferior first bicuspid and first 
and second molars, 387 
British gum, 80 
Broca's convolution, 181 
Bromids, 58, 60 
Bromin, 58, 60 
Bronchial breathing, 152 
tree, 124 

tubes, anatomy, 124 
Brown atrophy, 200 
Brown's porcelain bridge, 392 
Brunner's glands, 162 
Buboes, syphilitic, 308 
Buccal cavity, carcinoma of, causes, 211 

mucous membrane, syphilitic affections, lesions 

in, 217 
parietes, tumors, 214 
Buccinator muscle, anatomy, 113 
Budge's anospinal center in defecation, 157 
Buried suture, 289 
Burns from x-rays, treatment, 307 
Burr for forming floor of cavity for gold filling, 
337 
for opening and following course of sulci of 

teeth, 337 
for removing deep-seated decay, 337 
Button suture, 289 
Butyric acid fermentation, 69 

Cachexia, definition, 211 
Caffein, 237 

dose, 237 
Calcareous degeneration of arteries, 218 
Calcific metamorphosis, 202 
Calcification, 134, 202 

of permanent teeth, 141 

of tooth, 137, 138 
Calcium, 64 _ 

atomic weight, 31 

carbonate, 64 

flame test, 41 

hydrate, 64 

graphic formula, 29 

hypochlorite for bleaching teeth, 240 

in solution, seoaration, 41 

oxid, chemical formula, 27 

sulfate, 56, 64 

sulfite, chemical formula, 39 

symbol of, 27 
Calculus, pulp, 328 

diagnosis of irritation from, 329 
treatment, 328 

salivary, and pyorrhea alveolaris, differ- 
entiation, 335 
cause, prognosis and treatment, 335 



Calculus, diagnosis and treatment, 304 
Callus, 210, 297 

Calmette's ophthalmo-tuberculin test, 229 
Calomel, 62 

chemic name, 27 
Caloric value of food, 165 
Camphor, 69 
source, 251 
Canaliculi, 116 
Candle flame, 54 
Cane-sugar, 81 

conversion into grape-sugar, 81 
Capillaries, anatomy, 134 
b.le, 161 
functions, 150 

movements of blood-corpuscles in, 151 
pressure in, 149 
relation, to circulation, 150 
structure, 150 
Capillary attraction, 18 
Capped pulp, why, when, how, 265 
Capping pulp, 328 

symptoms contraindicating, 328 
Capsicum, dental uses, 243, 248 
Capsule, Bowman's, 129, 182 
Capsules, suprarenal, anatomy, 105 
Carat, 92 
Carbohydrates, 165 

action of gastric juice on, 159 
and hydrocarbons, 6S 
diet of, 167 
digestion, 166 
in metabolism, 173 
metabolism, 164 
physiologic uses, 165 
Carbolates, 73 
Carbolic acid, 73, 248 
antidote, 73 
as disinfectant, 263 
chemical antidotes, 249 
dental use, 248 

dose, for internal administration, 249 
in mouth conditions, 249 
injuries of mouth from, treatment, 304 
poisoning from, 249 

chemical treatment, 78 
treatment, 249 
properties, 249 
therapeutic uses, 238 
to obtund sensitivity of teeth, 327 
whence derived, 248 
Carbon, 53 

allotropic forms, 53 
dioxid, 54 

effect on health, 270 
on lime-water, 54 
formula and molecular weight, 41 
in air, 53 
monoxid, 54 

effect on health, 270 
Carbonic acid, formula, 30 

gas, chemical formula, 30 
Carbuncle, 207 

and furuncle, differentiation, 287 
Carcinoma, 211 

and sarcoma, histologic differences, 212 
channels disseminated through, 292 
metastatic extension, 211 
of buccal cavity, causes, 211 
of tongue, diseases mistaken for, 303 
glandular infection in, 304 
Kocher's operation, 303 
predisposing causes, 303 
pathologic histology, 213, 214 
pathology, 211, 213 
various types, 2 14 
Caries, 207 

and necrosis of bone, differentiation, 209 
dental, 209, 336 
classification, 336 
deep-seated, 337 
treatment, 337 
etiology, 337 
how distinguished, 265 
lactic acid in, 81 



IN I MX 



40I 



Caries, dental, superficial, 336 
treatment, 336 

treatment, preventive! •;: 
of lower third molar, treatment, 339 
pathology, 209 
Carotid artery, external, 10 1 
tanal, 1 17 
triangle, 115 
Cartilage, changes in, in arthritis deformans, 
210 
development, 132 
Meckel's, anatomy of, 132 
of larynx, 123 
varieties, 135 
Cascara sagrada, dose, 257 
Caseation, 202 
Caseinogen, function, 174 

Case's appliance for raising occulsion of lower 
bicuspids, 317 
retainer for anterior teeth, 320 
Cassius, purple of, 368 
Cast iron, 98 
Catabolism, 78, 173 
Cataphoric applications, 241, 242 
in dentistry, 242 

drugs useful for, 242 
Catarrh, nasopharyngeal, changes in (tissue in, 

219 
Catarrhal inflammation, 205 
Catelectrotonus, 180 
Cathartics, 257 
cholagogue, 257 
laxative, 257 
saline, 257 
Cathode, 25 
Cations, 30 
Cauda equina, 108 

Caustic alkalies, poisoning by, antidote, 77 
kali, chemical formula, 30 
lunar, chemical formula, 30 
medicines used as, 248 
natri, chemical formula, 30 
potash, chemical formula, 30 
soda, chemical formula, 30 
Cell, Daniel-, 25 
Cell-division, 198 
Cell-growth, 198 
Cells, bone, 116 

conversion of osteoblasts into, 135 
forming dentine, 138 
galvanic, 24 
goblet-, 169 
Grove-, 24 

in peridental membrane, 320 
mastoid, 121 
nerve-, 184 

structure and functions, 136 
nucleus of, 130 
reproduction, 130 
sphenoidal, 120 
structures in, 130 
Cellulitis, suppurative, 288 

treatment, 288 
Celluloid base, construction of artificial den- 
ture on, 367 
composition, 367 
Cellulose, 77 

Cement and amalgam for crowns, 347 
and gold filling, 349 
as retentive medium for bridges, 392 

for crowns, 392 
silicate, for filling, 350 
unsafe as filling, 341 
Cementum, 132, 137 
analysis, 138 
function, 194 
origin, 139 
thick, 139 
Centers of ossification, 134 
Centigrade thermometer, 20 
Central lobe, anatomy, 106 
Centrosomes, 198 
Cerebellum, function, 190 
Cerebral poisons, 76 
Cerebrum, gray matter, 189 
motor area, 190 

26 



Cerebrum, white matter, 189 
Cerumen, 177 

Cervical sympathetic nerve, section of, 187 

stimulation, 187 
Chancre, 308 

of lip, diagnosis and treatment* 309 
Charcoal, 53 
Chemical action, 35 

from electricity, 25, 34 
from light, 34 
affinity, 32 
affixes, 38 
antidote, 236 

and physiological antidotes, difference 

in action, 68 
for sugar of lead, 6a 
changes, 26 
compound, 27, 32 
force, 32 

incompatibility, 236 
reaction, 40 
reagent, 40 
suffixes, 38 
symbol, 27 
prefixes, 38 
Chemistry, 26 

analytic methods in, 40 
inorganic, 26 
organic, 68 
physiologic, 78 
synthetic methods in, 40 
Chemotaxis, negative, 222 
positive, 222 
varieties, 222 
Chest, changes in diameter, in respiration, 152 
Chloral, dose, 251 

hydrate mixed with alkali, reaction, 43 
indications for use in producing sleep, 243 
Chlorapercha, 331 
Chlorids, 58 
Chlorin, 58, 59 

action, on alcohol, 74 
gas, 59 
ions, 59 

method of refining gold, 93 
Chlorinated lime, 55, 59 
Chloroform, 71, 72 
as anesthetic, accidents from, 309a 
treatment, 309a 
method of administering, 309a 
in tooth extraction, 310 

collapse in, 310 
signs of danger, 311 
stages, 310 
successive steps, 3096 
composition, 3096 
effect on blood-pressure, 255 
local action, 254 
Cholagogue, cathartic, 257 
Cholesterin, physiology, 174 
Chondroma, 293 
Chorda tympani, anatomy, 109 

functions, 188 
Choroid, 128, 190 
Chromatin, 130 
Chromic acid, 246 

dental uses, 246 
Chromosomes, 198 
Chyle, 162, 170 
Chyme, 158, 162 
C catrix, 207 
Cilia, 124 
Ciliary body, 128, 190 

muscle, 190 
Cinnabar, 56, 98 

chemical name, 35 
Cinnamon, oil of, dental uses, 243 
Circle of Willis, 10 1 

Circulation, anesthetics depressing to, 255 
calcareous degeneration of arteries influenc- 
ing, 218 
effect of opium on, 260 

of tobacco on, 284 
entrance of digested food into, 170 
fetal, 195 
in kidneys, 182 



402 



INDEX 



Circulation, influence, on secretion of urine, 
182 
introducing medicines into, 234 
of blood, 147 
portal, 160 

relation of capillaries to, 150 
renal, 182 
Circulatory system, physiology, 147 
Circuit, 25 

Cisterns, storage, 274 
Citric acid, 75 

Clasp, broken, on rubber plate, repair, 
365 
gold, attached to rubber plate, 365 
formula for, 374 
method of making, 374 
metals making, for continuous gum partial 

denture, 376 
method of attaching, to gold plate, 374 
Cleft palate, 301 

acquired and congenital, differentiation, 

297 
surgical treatment, 301 
impression of, method of taking, 393 
Cleveland vacuum cavity, 367 
Climate and diseases, 269 
effect on human system, 269 
in pulmonary tuberculosis, 270 
Clonic muscular contraction, 179 
Cloves, oil of, 244 

as disinfectant, 263 
dental uses, 244 
dose, 244 
Coagulating antiseptic, 244 
Coagulation necrosis, 202 
of blood, 144, 145 
test for albumin, 82 
Coagulum, 145 
Coal, 53 

combustion of, products, 54 
oil, 74 
Coal-tar products, 73 

action on heart, 255 
in neuralgia, 250 
to reduce temperature, 237 
Cobalt magnets, 89 
Cocain, 7 5. 76 

and eucain, differences in physiologic action, 

250 
antagonists of, 250 
hydrochlorid, 249 
dose, 249 

how obtained, 249 

maximum dose, for hypodermic adminis- 
tration to adult, 250 
properties, 249 
local action, on blood-vessels, 261 
physiologic antidote to, 250 
poisoning from, symptoms, 250 
treatment, 250 
Coccus, definition, 220 
pathogenic, 220 

in furunculosis, 220 
in purulent salpingitis, 220 
in tonsillitis, 220 
pus, steam as destroyer, 282 
Coccygeal gland, functions, 175 

sympathetic ganglia, n 1 
Codein, dose, 251, 260 
Coffee, physiologic uses, 165 
Cohesion, 17, 18 

Cohnheim's theory of tumors, 211 
Coin, gold, carat and alloy, 94 
Cold in inflammation, 286 
indications for use, 246 
metals conductors, 89 
physiologic effect, on tissues, 246 
Collapse in anesthesia, 310 

in chloroform anesthesia for teeth extrac- 
tion, 311 
Collateral hyperemia, 199 
Collodion, 74 
Colloid degeneration, 202 
Color blindness, 192 
sensations, 192 



Columnar epithelium, microscopic appearance, 

133 

Columns of spinal cord, functions, 189 

Combination fillings, 348 
Combustible substances, 48 
Combustion, 34 
slow, 48 
spontaneous, 34 
supporter of, 48 
Compact bone, 115 
Complement, 232 
Complemental air, 153 

Compound substances, physical forces de- 
composing, 33 
Compounds, constituents of, obtaining, 28 
Compressed air in dentistry, 246 
Concentric lamellae, 115 
Condensing osteitis, 210 
Conductors of electricity, 25 
Condyloid foramen, 117 
Congestion, 286 
active, 286 

and inflammation, differences, 286 
passive, 286 
Cones of retina, 192 
Congestion and inflammation, differentiation, 

205 
Conjunctival test, 229 
Connective tissue, anatomy, 122, 135 
function, 13S 

intercellular constituents, 135 
Connective-tissue tumors, 211 
Contagious diseases, precautions of physician 
against transmission, 279 
transmission, 278 
Continued suture, 289 

Convulsions in dentition, remedies for, 238 
Cooking, effect on food, 163 
Copper amalgam, 99 
fusing-point, 89, 370 
sulfate, common name, 43 
dental use, 239 
in phosphorus poisoning, 77 
poisoning, antidote, 76 
properties, 239 
Copperas, chemical name, 27 
Cores, method for making and using, 375 
Cornea, 128, 190 
Cornicula, 123 

Cornua of spinal cord, functions, 189 
Coronary arteries, 100 
Corpus callosum, anatomy, 106 
Corpuscles, muscle, 179 
of Hassall, 105 
of Meissner, 136 
pus-, development, 207 
red, 103, 145, 146 

movements, in capillaries, 151 
white, 103, 146 
definition, 227 

movements, in capillaries, 151 
Corrosive poisons, 252 
antidotes for, 252 
physiologic action on tissue, 252 
sublimate, 63 

poisoning, eggs in, 76 
Corti, organs of, 193 
Cosmolin, 74 
Cotton underwear, 267 
Coulomb, 24 
Counter-die, definition, 375 

metals used for, 375 
Counterirritant containing drugs, prescrip 
tion for, 264 
definition, 246 
three, 248 
used in mouth, 246 
Counter-sunk pin teeth, advantages, 369 
Cow's milk diseases transmitted by, 277 
Cover-glass preparations, staining, 225 
Cranial dura mater, anatomy, 105 
nerves, anatomy, 108 

fifth, anatomy, 109, no 
functions, 188 
ganglia, 109 






INl'l X 



403 



Cranial nerves, fifth, third division, 109 
first, function, 187 
for special sense, rS 7 
fourth, anatomy, 10S 
motor, 187 
seventh, anatomy, 1 10 

paralysis of, 188 
sixth, anatomy, 110 
third, anatomy, 108 
sinuses, 105, 106 
Cranium, bones, 116 
Cream of tartar, 64 
Cremation, advantages, 275 
Creosote, 73, 244, 248 
antidotes for, 244 
dental uses, 244, 248 
dose, 244 

whence derived, 248 
Cretinism, 218 

with what associated, 218 
Cribriform plate, 120 
Cricoid cartilage, 123 
Crista galli, 120 
Croup, laryngeal, and spasmodic croup, 

differences, 216 
Croupous inflammation in diphtheria, 216 
Crown, amalgam and cement for, 347 

bicuspid, porcelain faced, construction, 383 

with porcelain front, construction, 379 
Bonwill, 380 
carat and gauge of plate most desirable for, 

383 ,- r 

cement as retentive medium for, 392 

Davis, 380 

advantages of, 380 

process of adapting, 380 
dowel, reinforcing root for, 386 
for cuspid, construction, 384 
guttapercha as retentive medium for, 392 
indications and contraindications, 322 
investment for, 388 

jacked, bicuspid, with porcelain facing, 378 
Tusti removable pin, 379 
Logan, 382 

banded, of cuspid, construction, 382 

method of setting, with guttapercha, 382 
Mason detachable porcelain faced, 382 
method of preparing molar for, 384 

of taking impression for, 386 
molar, 385 
pain in surrounding parts after, treatment, 

386 
pin, detached, advantages of, 382 

Tusti removable, 379 

reinforcing root for, 386 
platinum and porcelain, construction, 380 
porcelain and platinum, construction, 380 

faced, with split post, for upper cuspid, 
to be used as one end of removable 
bridge, 389 

platinum base, construction, 379 
removal, from diseased molar tooth, 386 
requisites, 378 
Richmond, 381 

preparing root, 381 

removing, to repair broken facing, 382 

soldering, 381 

with broken facing, repair, 381 
shell, for badly decayed molar crown, 385 

method of adding a low-fusing porcelain 
face to, 379 
to restore abraded front teeth, 380 
where teeth have moved together, 378 
with hole, repair, 386 
Crude rubber, where and how obtained, 361 
Crypts, Lieberkuhn's, 125, 162 
Crystal gold, 94 
Crystalline lens, anatomy, 128 

physiology, 191 
structure, 40 
Crystallization, conditions favorable to, 33 
Culture, definition, 223 
how made, 223 
object, 223 
on potato, mode, 225 



Culture-media, 2?^, 224 
fluid, sterilization, 225 

sterilization, 224 
Cuneiform cartilages, 123 
Cuneus, 193 
Cupric nitrate, formula, 30 

sulfate, 55 
Curative treatment, 235 
Cuspid, Angel's appliance for retracting, 319 

banded Logan crown, construction, 382 

extraction, 353 

gold crown, construction, 384 

permanent, 142 
retention of, 142 

preparation of cavities for filling on prox- 
imal surface, 340 

retaining, when removing other teeth, 356 

right upper, method of bringing into posi- 
tion, 318 

unerupted, method of drawing into position, 

317 
upper, porcelain faced crown with split 
post, to be used as one end of a removable 
bridge, 389 
Cutaneous fat, 177 
Cutis vera, 127 
Cyanogen, 58 
Cystic duct, 161 

hygroma, congenital, 218 
ovary, pathology, 215 
Cysts, 214 
dermoid, 293 

of tongue, 301 
formation, 214 
of alveolar process, 215 
of tongue, 301 
retention, 215 
of tongue, 301 
treatment, 301 
varieties, 214 

Daniel-cell, 25 
Daughter stars, 198 
Davis crown, 380 
advantage, 380 
process of adapting, 380 
Death, definition, 184 
Death-rate, 270 
Decay, 72 

in deciduous teeth, treatment, 324 
of teeth, deep-seated, burr for removing, 
337 
excavator points for removing, 337 
prevention, in applying bands and regu- 
lating appliances, 320 
silver nitrate arresting, 324 
white, of teeth, treatment and care, 340 
Deciduous teeth, abscess, dangers, 267 
treatment, 324 
canals of, filling, 324 
cavities in, treatment, 324 
decay in, treatment, 324 
exposed pulp in, treatment, 323 
with pain, treatment, 325 
extraction, premature, evils from, 352 
objections, 265 
results after, 321 
when indicated, 352 
filling materials for, 324 
indications for use of lance in, 304 
lancing gums, 325 
loss of, physiology, 194 
resorption of roots, 264 
treatment, 264 

that will insure health of oral cavity 
and regularity of permanent teeth, 

^ , • 325 
Decubitus, 207 

Deep reflexes, 186 

Defecation, 157 

Degeneration, 200 

albuminoid, 201 

amyloid, 201 

and infiltration, differentiation, 200 

calcareous, of arteries, 218 



404 



INDEX 



Degeneration, colloid, 202 
fatty, 200 

and fatty infiltration, differentiation, 200 
of what a symptom when affecting paren- 
chymatous cells, 200 
fibrinous, 202 
hyaline, 202 
in lymph-glands, 201 
mucoid, 202 
myxomatous, 202 
Degenerative changes of arteries, 218 

inflammation of bone, 210 
Deglutition, 156 

muscles, 114 
Deliquescence, 23 

Demarcation, line of, in gangrene, 208 
Denatured alcohol, 73 
Dendrons, 185 
Denitrocellulose, 77 
Densimeter, 22 

Dental arch, superior, formation, facial 
muscles affecting, 313 
artery, inferior, 10 1 
caries. See Caries, dental. 
fibrillae, 139 
foramen, inferior, 118 
groove, primitive, 131 
nerve, inferior, exposure of, 300 
papilla, development, 131 

tissues formed by, 13 x 
ridge, 131 
Dentin, 132, 137 

action on, of remedies used to obtund sen- 
sitivity, 326 
analysis, 138 
cells forming, 138 
development and formation, 139 
hypersensitive, 326 

treatment, 265, 326 
matrix of, 138 

principal chemical element in, 138 
result of exposing to acid, 139 
secondary, deposit of, 327 
formation of, 138 
purpose of, 138 
sensitive, and pulp irritation from loss of 
tooth substances, differentiation, 268 
Dentinal fibers, 138 

tubules, 139 
Dentine, chemical constituents, 86 
Dentist, hygienic measures by, after opera 

tions, 272 
Dentistry, operative, 322 

prosthetic, 355 
Dentrifice, desirable, ingredients of, 247 

properties should possess, 247 
Denture, artificial, aluminum in construction , 
376 
base hygienically best, 376 
causes of failure, 358 
construction, on celluloid base, 367 
on gold base, 372 
on vulcanite base, 363 
Griswold retainer for, 366 
impression for, conditions considered, 

356. 
lower, construction, by cheoplastic proc- 
ess, 368 
materials as base for, 361 
methods of retaining, 366 
essentials for retention, 366 
gum, continuous, advantages of, 377 
construction of, 377 
method of replacing broken tooth from, 
377 
kind of, where superior canines and second 

molars are in position, 374 
lower, gold plate for, gauge and carat, 371 
full, what determines outlining, 3 56 
muscles displacing, 356 
partial, of gold, 372 
perfectly fitting, essential requirements, 358 
permanent, 358 
porcelain, construction, 377 
temporary, 358 



Denture, upper, fit of, effect of hard center 
and soft ridge on, 358 
form of the surface back of incisors, 364 
gold plate for, gauge and carat, 37